Day Hospitalization Department, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Pediatric Infectious Diseases Unit, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
Pediatr Blood Cancer. 2021 May;68(5):e28856. doi: 10.1002/pbc.28856. Epub 2020 Dec 22.
Catheter-related infections are difficult to cure, and failure rates are high. We aimed to evaluate the efficacy and safety of ethanol lock therapy (ELT) as catheter salvage strategy in children with central-line-associated bloodstream infection (CLABSI), and to identify factors associated with treatment failure.
Data were collected of all the children who received ELT for treatment of CLABSI during 2013-2018 due to failure of standard therapy or multiple catheter-related infections. Univariate and multivariate analyses of risk-factors for ELT failure were performed. Catheter salvage rates were compared to those achieved using systemic antimicrobials alone in an historical control group.
A total of 123 ELT episodes among 95 patients were analyzed. The majority of patients had underlying hemato-oncological disorders. Approximately half the episodes occurred in patients with implantable ports. Early and late treatment failure rates of ELT were 16% (20/123) and 7% (9/123), respectively. Overall, successful catheter salvage was achieved in 78% (96/123) of episodes, compared to 54% using systemic antimicrobials alone (P < .001), including mycobacterium, candida, and most staphylococcus aureus infections. Adverse events were reported in 9% (11/123) of episodes and were mostly mechanical. Multivariate analysis identified four risk factors for ELT failure: Gram-positive bacteria, elevated C-reactive protein, signs of tunnel infection, and low absolute neutrophil counts.
Our findings support the use of ELT for catheter salvage in children with CLABSI who failed standard therapy or had multiple catheter-related infections. The identified variables associated with ELT failure may help identify patients who can most benefit from ELT.
导管相关感染难以治愈，且失败率较高。本研究旨在评估乙醇锁疗法（ELT）作为儿童中心静脉相关血流感染（CLABSI）导管挽救策略的疗效和安全性，并确定与治疗失败相关的因素。
收集了 2013 年至 2018 年期间，因标准治疗失败或多次导管相关感染而接受 ELT 治疗 CLABSI 的所有儿童患者的数据。对 ELT 失败的危险因素进行单因素和多因素分析。将 ELT 组的导管挽救率与单独使用全身抗菌药物的历史对照组进行比较。
共分析了 95 例患者的 123 次 ELT 治疗。大多数患者患有血液系统恶性肿瘤。大约一半的病例发生在植入式端口的患者中。ELT 的早期和晚期治疗失败率分别为 16%（20/123）和 7%（9/123）。总的来说，123 次 ELT 治疗中有 78%（96/123）成功挽救了导管，而单独使用全身抗菌药物的成功率为 54%（P<0.001），包括分枝杆菌、假丝酵母菌和大多数金黄色葡萄球菌感染。9%（11/123）的病例报告了不良事件，主要为机械性的。多因素分析确定了 ELT 失败的四个危险因素：革兰氏阳性菌、C 反应蛋白升高、隧道感染迹象和绝对中性粒细胞计数低。
本研究结果支持对标准治疗失败或有多次导管相关感染的 CLABSI 儿童患者使用 ELT 进行导管挽救。确定与 ELT 失败相关的变量可能有助于识别最受益于 ELT 的患者。
