Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial.

Abstract

RATIONALE:

Ethanol rapidly eradicated experimental biofilm. Clinical studies of ethanol lock to prevent catheter-related infections (CRIs) suggest preventive efficacy. No such studies have been done in intensive care units (ICU).

OBJECTIVES:

To determine whether ethanol lock decreases the risk of major CRI in patients with short-term dialysis catheters (DCs).

METHODS:

A randomized, double-blind, placebo-controlled trial was performed in 16 ICUs in seven university hospitals and one general hospital in France between June 2009 and December 2011. Adults with insertion of a nontunneled, nonantimicrobial-impregnated double-lumen DC for an expected duration greater than 48 hours, to perform renal-replacement therapy or plasma exchange, were randomly allocated (1:1) to receive a 2-minute catheter lock with either 60% wt/wt ethanol solution (ethanol group) or 0.9% saline solution (control group) at the end of DC insertion and after each renal-replacement therapy or plasma exchange session. The main outcome was major CRI defined as either catheter-related clinical sepsis without bloodstream infection or catheter-related bloodstream infection during the ICU stay.

MEASUREMENTS AND MAIN RESULTS:

The intent-to-treat analysis included 1,460 patients (2,172 catheters, 12,944 catheter-days, and 8,442 study locks). Median DC duration was 4 days (interquartile range, 2-8) and was similar in both groups. Major CRI incidence did not differ between the ethanol and control groups (3.83 vs. 2.64 per 1,000 catheter-days, respectively; hazard ratio, 1.55; 95% confidence interval, 0.83-2.87; P = 0.17). No significant differences occurred for catheter colonization (P = 0.57) or catheter-related bloodstream infection (P = 0.99).

CONCLUSIONS:

A 2-minute ethanol lock does not decrease the frequency of infection of DCs in ICU patients. Clinical trial registered with www.clinicaltrials.gov (NCT 00875069).

• Authors: Bertrand Souweine, Alexandre Lautrette, Didier Gruson, Emmanuel Canet, Kada Klouche, Laurent Argaud, Julien Bohe, Maïté Garrouste-Orgeas, Christophe Mariat, François Vincent, Sophie Cayot, Olivier Cointault, Alain Lepape, Dominique Guelon, Michael Darmon, Aurélien Vesin, Nicolas Caillot, Carole Schwebel, Alexandre Boyer, Elie Azoulay, Lila Bouadma, Jean-François Timsit
• Journal: American journal of respiratory and critical care medicine (Am J Respir Crit Care Med) Vol. 191 Issue 9 Pg. 1024-32 (May 01 2015) ISSN: 1535-4970 [Electronic] United States
• PMID: 25668557 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Infective Agents
• Ethanol

Topics

• Aged
• Anti-Infective Agents (pharmacology)
• Catheter-Related Infections (etiology, prevention & control)
• Catheterization, Central Venous (adverse effects)
• Catheters, Indwelling (adverse effects)
• Critical Care (methods)
• Critical Illness
• Double-Blind Method
• Ethanol (pharmacology)
• Female
• France
• Humans
• Infection Control (methods)
• Male
• Middle Aged
• Renal Dialysis