70% Ethanol Lock for Management of Catheter-Related Blood-Stream Infection in Tunneled Central Venous Catheters

Background Tunneled cuffed central vein catheters (TCC) are extensively used for maintenance hemodialysis (HD). They may develop biofilms and cause catheter-related blood-stream infection (CRBSI). Commonly used antibiotic locks poorly penetrate biofilms, resulting in treatment failure and catheter removal. A potent microbicide that can penetrate biofilms is 70% ethanol. We used an ethanol lock (EL) for the treatment of CRBSI from TCC. Materials and Methods It is a retrospective three year cohort study. An EL was applied to catheter lumens for four hours. In the end, EL was syringed out, and catheters were relocked with heparin. This was repeated for five days. Appropriate systemic antibiotics were administered. Results The study group had 70 patients with CRBSI from TCC. The mean age was 50±16 years; 65% were males, and 49% had diabetic nephropathy. CRBSI rate was 2.7 per 1000 patient days. The first CBRSI episode occurred within 86 days (Interquartile range 44-176 days). Gram-negative bacteria caused 60% of infections. Catheter salvage was possible in 95% of patients. Survival analysis with log-rank test showed no difference between infected and non-infected catheters’ half-life ( p = 0.42). No adverse events were seen. Conculsion In CRBSI treatment, 70% EL therapy with systemic antibiotics salvaged 95% of TCCs.