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Ethanol locks reduce central venous catheter-associated bloodstream infections in children with cancer
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Ethanol locks prevented central venous catheter-associated bloodstream infections in pediatric patients with cancer, according to the results of a randomized trial.
“The use of central venous catheters (CVC) is indispensable in the modern-day treatment of children with cancer,” Marianne D. van de Wetering, PhD, MMed, FCP(SA), pediatric oncologist at Emma Children’s Hospital Academic Medical Centre in Amsterdam, and colleagues wrote. “Despite improved international guidelines on CVC placement and catheter care, CVC colonization is still an important problem in such patients. Colonized CVCs can cause CVC-associated bloodstream infections (CABSI), with reported infection rates between 0.1 and 2.3 CABSIs per 1,000 catheter days.”
The use of ethanol locks can potentially eliminate pathogens colonizing CVCs with minimal microbial resistance, according to study background.
Van de Wetering and colleagues conducted a randomized controlled trial to determine whether 2-hour, 70% ethanol locks could reduce CABSI in pediatric patients with cancer.
The trial comprised 307 patients aged 1 to 18 years with newly inserted CVCs. Patients received 2-hour ethanol locks (1.5 mL or 3 mL, 70%; n = 153) or heparin locks (1.5 mL or 3 mL, 100 IU/mL; n = 154) as needed, with maximum frequency once weekly.
Seventy patients discontinued the study prematurely. Significantly more patients in the ethanol arm withdrew their informed consent (20 vs. 8; P = .031).
Time to CABSI or death due to CABSI served as the primary endpoints.
The researchers observed a CABSI in 10% (n = 16) of patients in the ethanol arm vs. 19% (n = 29) in the heparin arm. Further, patients in the ethanol arm experienced fewer CABSI per 1,000 catheter days (0.77 vs. 1.46; P = .039).
No patients died from CABSI, and patients in the ethanol arm experienced a reduction of gram–positive CABSIs (8 vs. 21; P = .012). Further, fewer CVC removals due to CABSI occurred among patients on ethanol locks (P = .077).
No suspected and unexpected serious adverse reactions occurred. More patients in the ethanol arm than heparin arm reported nausea (P =.03), taste alteration (P < .001), dizziness (P = .001) and blushing (P < .001); however, adverse event symptoms remained transient and did not exceed grade 2. Serious adverse events occurred at similar rates in both arms (ethanol, n = 65; heparin, n = 67).
The researchers acknowledged several limitations of their study, including poor trial accrual and inequality of the number of patients who withdrew consent following randomization.
“We therefore recommend the implementation of prophylactic prophylactic ethanol locks in current pediatric oncology practice with the following caveats,” van de Wetering and colleagues concluded. “Firstly, as some patients may have withdrawn from the study because of adverse events, patients should be well informed as to the potential side effects and their transient nature. Secondly, as the diagnosis of CABSI in pediatric oncology patients remains a challenge, for future studies we recommend standard definitions for CABSI applicable to pediatric patients, such as the use of differential time to positivity. Lastly, while shorter lock durations would be more convenient for patients and their families, shorter dwell times/even ethanol flushes, should be compared to 2-hour locks for efficacy.” – by Cameron Kelsall
Disclosure: van de Wetering reports no relevant financial disclosures. One researcher reports an employment role with F. Hoffman-La Roche Ltd.
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