TITLE:
Ethanol Lock Therapy as additional treatment of catheter-related bloodstream infections in pediatric patients receiving home parenteral nutrition
AUTHORS:
Merel N. van Kassel, Dasja Pajkrt, Jim C. H. Wilde, Cora F. Jonkers, Merit M. Tabbers
KEYWORDS:
Home Parenteral Nutrition; Ethanol Lock Treatment; Catheter Related Bloodstream Infections
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.3 No.4,
December
16,
2013
ABSTRACT:
Background: Catheter related bloodstream infections (CRIs) are a major cause of morbidity,
mortality and prolonged hospitalization in pediatric patients with home
parenteral nutrition (HPN). In recent years, new prophylactic and treatment
options have been evaluated to reduce the incidence of CRIs and infection
related catheter removals. In children, two retrospective studies have shown
the efficacy of ethanol lock treatment (ELT) in reducing the incidence of CRIs
in pediatric oncology patients. However, prospective data are missing. Our aim
of the present study was to evaluate prospectively the effect of ELT on the
cure and recurrence rate of CRIs, duration of hospitalization and antibiotic
use in HPN pediatric patients. Methods: HPN children older than three months with a clinical suspicion of a CRI were included
and randomised to ELT or standard flushing treatment (heparin or taurolidine).
The primary outcomes were persistence and recurrence of the bacteraemia and
Central Venous Access Device (CVAD) removal. Secondary outcomes included
duration of antibiotic use, duration of hospitalization and side effects. Results: Data from eight HPN children experiencing
14 suspected CRI were analysed. Seven patients had proven CRIs by positive
blood cultures. Four were treated with ELT and three with their standard
flushing treatment. One CRI persisted in the control group. In one single
patient, bacteraemia recurred three times within 24 weeks. This patient had
been enrolled in both study arms. A CVAD removal was needed in one patient
because of occlusion. Conclusions: This small study showed no additional efficacy of the use of ELT on cure rate
or recurrences of CRIs compared to standard therapy in HPN treated children.
There were also no differences in duration of hospitalization, the use of
antibiotics or CVAD removal between both groups.