Ethanol Lock Therapy for Salvage of Infected Tunnelled Haemodialysis Catheters: A Randomised Controlled Trial

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Ethanol Lock Therapy for Salvage of Infected Tunnelled Haemodialysis Catheters: A Randomised Controlled Trial

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Co-author 1

HARI PRASAD M K prasadhari520@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India *

Co-author 2

LALIT K PURSNANI drlalitkpursnani@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 3

MUTHUKUMAR BALKRISHNAN itzmedrmuthu@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 4

HIMANSU SEKHAR MAHAPATRA hsmnephro@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 5

VIPIN DEV dr.vipindev@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 6

DISHA ARORA doctordisha14091994@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 7

VARUNA YADAV varunayadav15@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 8

RENJU BINOY renjubinoy855@gmail.com Atal Biharee Vajpayee Instiute of Medical Science and Dr Ram Manohar Lohia Hospital Nephrology Delhi India -

Co-author 9

Co-author 10

Co-author 11

Co-author 12

Co-author 13

Co-author 14

Co-author 15

Introduction

Tunnelled catheter-related bloodstream infections (CRBSIs) in haemodialysis are challenging to manage due to biofilm formation. Ethanol lock therapy (ELT) has demonstrated potential as an adjunct to antibiotics for catheter salvage, but robust evidence is limited.

Methods

We conducted a single-centre, open-label, randomised controlled trial of adult haemodialysis patients with suspected or confirmed CRBSI. Patients received either 70% ethanol lock therapy plus intravenous antibiotics or intravenous antibiotics alone. Primary outcome was catheter salvage at Day 7. Secondary outcomes included recurrence at Day 60, catheter survival, and adverse events

Results

Eighty-four patients were randomised (42 per arm). Coagulase-negative Staphylococcus was the most common pathogen (34.5%). Early catheter salvage was higher with ethanol lock (78.6% vs 57.1%; P = 0.035). Recurrence was lower with ethanol lock at Day 60 (20.5% vs 53.7%; P = 0.002). Median catheter survival was longer (15 vs 8 days), though not statistically significant (P = 0.283). Fever resolution by Day 7 was significantly higher in the ethanol lock group compared to control (64.3% vs. 35.7%, P = 0.009). Adverse events were infrequent and mild. In multivariate analysis, higher serum albumin was independently associated with increased likelihood of catheter salvage (OR 2.43, P = 0.038), while longer dialysis vintage (OR 0.90, P = 0.035) and Pseudomonas infection (OR 0.05, P = 0.014) were associated with reduced salvage rates

Conclusion

Adjunctive ethanol lock therapy improved early catheter salvage and reduced recurrence without significant adverse effects. These findings support its use as part of salvage protocols in tunnelled catheter infections

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