Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Cardiac Surgery Postoperative Care Unit, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias - CIBERES (CB06/06/0058), Madrid, Spain.
J Hosp Infect. 2018 Nov;100(3):e187-e195. doi: 10.1016/j.jhin.2018.04.007. Epub 2018 Apr 10.
Ethanol-based lock therapy (LT) solutions are used as an alternative to antibiotics for the conservative management of catheter-related bloodstream infection. However, no clear consensus on regimen or dose has been reached.
To find the ethanol-based lock solution containing a sufficiently low concentration of ethanol for reduction of the metabolic activity of bacterial and fungal biofilms.
Using an in-vitro model, three concentrations of ethanol (25%, 40%, 70%) were tested, with and without 60 IU of heparin, at six different time-points and against 24 h preformed biofilms of Staphylococcus aureus ATCC29213, Staphylococcus epidermidis (clinical isolate), Enterococcus faecalis ATCC33186, Candida albicans ATCC14058, and Escherichia coli ATCC25922. The reduction in the metabolic activity of the biofilm was measured using the tetrazolium salt assay and LT was considered to be successful when metabolic activity fell by >90%. Regrowth inhibition was then tested within 24 h and seven days after each LT regimen only at the ethanol concentration of the most successful LT regimen.
The most successful LT was achieved with 40% ethanol + 60 IU of heparin only at 24, 72, and 24 h for seven-day regimens (P < 0.05). However, none of the regimens reached 45% RI within seven days of therapy.
According to our in-vitro data, an ethanol-based lock solution with 40% ethanol + 60 IU heparin administered daily for 72 h is sufficient to almost eradicate the metabolic activity of bacterial and fungal biofilms. Future studies are needed to study cell regrowth after LT.
乙醇基封管疗法（LT）溶液被用作抗生素的替代品，用于导管相关血流感染的保守治疗。然而，在方案或剂量方面尚未达成明确共识。
寻找一种乙醇基封管溶液，其乙醇浓度足够低，以降低细菌和真菌生物膜的代谢活性。
使用体外模型，测试了三种浓度的乙醇（25%、40%、70%），分别在有和没有 60IU 肝素的情况下，在六个不同的时间点，并针对金黄色葡萄球菌 ATCC29213、表皮葡萄球菌（临床分离株）、粪肠球菌 ATCC33186、白色念珠菌 ATCC14058 和大肠杆菌 ATCC25922 的 24 小时预形成生物膜。使用四唑盐测定法测量生物膜的代谢活性，当代谢活性下降>90%时，LT 被认为是成功的。然后仅在最成功的 LT 方案的乙醇浓度下，在每次 LT 方案后 24 小时和 7 天内测试再生长抑制。
仅在 24、72 和 24 小时的 7 天方案中，40%乙醇+60IU 肝素的 LT 最为成功（P<0.05）。然而，在 7 天治疗内，没有一种方案能达到 45%的 RI。
根据我们的体外数据，每天给予 40%乙醇+60IU 肝素的乙醇基封管溶液，持续 72 小时，足以几乎消除细菌和真菌生物膜的代谢活性。需要进一步的研究来研究 LT 后的细胞再生长。
