Division of Haematology and Oncology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA; Wayne State University, Detroit, MI, USA.
Haemophilia. 2014 Jan;20(1):52-7. doi: 10.1111/hae.12241. Epub 2013 Aug 1.
Obtaining a reliable venous access is a limiting factor for early initiation of clotting factor prophylaxis and immune tolerance induction. To circumvent this issue, central venous access devices (CVADs) are increasingly being used. Catheter-related infections (CRIs) remain the primary complication of insertion of CVAD. Thus, newer strategies for treatment and prevention of CRI are needed. Ethanol lock therapy (ELT) has been used to treat and prevent CRI in non-bleeding disorder patients. The aim of this study was to assess the efficacy of ELT in treating and preventing CRI in bleeding disorder patients. The medical charts of patients with bleeding disorders who underwent ELT for antimicrobial resistant CRIs were reviewed and data were analysed. ELT was effective in catheter salvage in 87% of patients with antimicrobial resistant CRI by a wide variety of pathogens. Prophylactic therapy with ethanol lock was associated with catheter dysfunction especially in mediports. ELT should be considered prior to removal of catheters in bleeding disorder patients with resistant CRIs. Further studies are needed for using prophylactic ethanol lock in prevention of CRIs in bleeding disorder patients.
获得可靠的静脉通路是早期启动凝血因子预防和免疫耐受诱导的限制因素。为了规避这个问题，越来越多地使用中心静脉通路装置（CVAD）。导管相关感染（CRI）仍然是插入 CVAD 的主要并发症。因此，需要新的策略来治疗和预防 CRI。乙醇封管疗法（ELT）已被用于治疗和预防非出血性疾病患者的 CRI。本研究旨在评估 ELT 在治疗和预防出血性疾病患者 CRI 中的疗效。回顾了接受 ELT 治疗抗微生物耐药性 CRI 的出血性疾病患者的病历，并进行了数据分析。ELT 对多种病原体引起的抗微生物耐药性 CRI 患者的导管挽救率达到 87%。乙醇封管预防性治疗与导管功能障碍有关，尤其是在药物港。对于耐药性 CRI 的出血性疾病患者，在移除导管之前应考虑 ELT。需要进一步的研究来使用预防性乙醇封管预防出血性疾病患者的 CRI。
