Ethanol lock therapy for catheter-associated blood stream infections in a pediatric intensive care unit.

ABSTRACT

OBJECTIVE: Ethanol locks are being used to prevent and eradicate central venous catheter infections. This study describes the efficacy of ethanol locks in clearing central venous catheter infections in a pediatric intensive care unit. DESIGN: Retrospective chart review. SETTING: Pediatric intensive care unit in a tertiary care children's hospital. PATIENTS All patients who received ethanol lock therapy for the treatment of catheter-associated bloodstream infections from January 2008 through December 2009. INTERVENTIONS: Ethanol locks of central venous catheters. MEASUREMENTS AND MAIN RESULTS: The study period encompassed 26 catheter-associated bloodstream infections that were treated with ethanol lock therapy. Each catheter-associated bloodstream infection was defined by criteria set forth by the Centers for Disease Control/National Healthcare Safety Network 2008. Patients ranged in age from 77 days to 20 yrs. Of the 26 central venous catheters with associated bloodstream infections, 24 (92%) were sterilized as evidenced by negative repeat blood cultures obtained within 48 hrs of the initiation of the ethanol lock. Thirteen of the 26 treatment ethanol locks were single doses. The dwell times ranged between 4 and 48 hrs with a mean dwell time of 17 hrs. Twenty of the 26 catheters (77%) continued to be used, while six, which included the two treatment failures, were removed. CONCLUSIONS: Ethanol locks using 70% ethanol solution with dwell times as short as 4-6 hrs in conjunction with standard antibiotic therapy have 92% effective clearance of catheter-associated bloodstream infection and a 77% catheter salvage rate in our pediatric intensive care unit. The use of 70% ethanol locks appears to be well tolerated and represents a relatively inexpensive pharmacologic intervention that, along with systemic antibiotics, can help treat catheter-associated bloodstream infections and salvage central venous catheters.