title: Hydrochloric acid treatment of tunneled central venous catheter infections in children with cancer.
abstract: BACKGROUND
  Long-term tunneled central venous catheters (CVCs) are often the source of catheter-associated bloodstream infections (CABSIs), which may be difficult to eradicate and may lead to premature catheter removal.
  
  
  METHODS
  This prospective controlled study used instillation of 2 M hydrochloric acid (HCl) as an adjuvant to the intravenous antibiotic treatment of children with bacteremia and compared the results with those from the immediate preceding period. The primary outcome variable was infection-related CVC removal within 100 days of bacteremia. Only patients with double lumen Hickman CVC with external tubings were included.
  
  
  RESULTS
  During a period of 36 months, 109 episodes of bacteremia were treated, 51 during the period where HCl was not used and 58 during the period where HCl was used. Forty-two out of 58 bacteremias were treated with HCl during the "HCl period." An intention-to-treat analysis showed that the median time to infection-related CVC removal was significantly longer during the HCl period compared with the non-HCl period (94 d vs. 12.5 d). At day 100 significantly more CVCs remained in place compared with the non-HCl period. Of the 42 CVCs treated with HCl, 2 had to be removed because of infection before day 30 and further 7 CVCs were removed before day 100. There was no difference in the occurrence of new bacteremias within the first 30 days of bacteremia in the 2 groups.
  
  
  CONCLUSIONS
  HCl may successfully supplement intravenous antibiotics in the treatment of CABSI and contribute to CVC salvage.
authors.affiliation: Department of Paediatrics, Aarhus University Hospital, Skejby, Denmark. henrik.schroeder@skejby.rm.dk
authors.forename: Line Nordahl
authors.initials: LN
authors.lastname: Larsen
authors.forename: Emma
authors.initials: E
authors.lastname: Malchau
authors.forename: Brian
authors.initials: B
authors.lastname: Kristensen
authors.forename: Henrik
authors.initials: H
authors.lastname: Schroeder
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000209:etiology; D055499:Catheter-Related Infections / Q000188:drug therapy*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002408:Catheters, Indwelling / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D006801:Humans; D006851:Hydrochloric Acid / Q000627:therapeutic use*; D007223:Infant; D007231:Infant, Newborn; D009369:Neoplasms / Q000150:complications*
chemical_list: D000900:Anti-Bacterial Agents; D006851:Hydrochloric Acid