title: Adjunctive management of central line-associated bloodstream infections with 70% ethanol-lock therapy.
abstract: OBJECTIVE
  Ethanol is bactericidal against most pathogens implicated in central line-associated bloodstream infections (CLABSIs) and biofilms. Current Infectious Diseases Society of America guidelines cite insufficient evidence to support adjunctive ethanol-lock therapy (ELT) for central venous catheter (CVC) salvage in patients with CLABSI in combination with systemic antimicrobial treatment. We evaluated the safety and potential efficacy of 70% ELT for CLABSI at our institution after implementation of a hospital ELT protocol.
  
  
  METHODS
  We collected data on all patients treated with adjunctive 70% ELT for catheter salvage from September 2009 to September 2011 and assessed clinical outcomes and adverse events associated with ELT.
  
  
  RESULTS
  Sixty-eight hospitalized patients received 70% ELT for CVC salvage: 45 (66%) met the criteria for CLABSI. Five (11%) had persistent or recurrent bacteraemia triggering CVC removal; 28 (62%) preserved their CVC long term. There were no documented adverse events associated with ELT.
  
  
  CONCLUSIONS
  Adjunctive 70% ELT is an inexpensive, well-tolerated option for CVC salvage in patients with CLABSI and warrants further investigation.
authors: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA dwkubiak@partners.org.
authors: David W
authors: DW
authors: Kubiak
authors: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Erin T
authors: ET
authors: Gilmore
authors: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Mary W
authors: MW
authors: Buckley
authors: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
authors: Robert
authors: R
authors: Lynch
authors: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA Harvard Medical School, 250 Longwood Avenue, Boston, MA 02115, USA.
authors: Francisco M
authors: FM
authors: Marty
authors: Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA Harvard Medical School, 250 Longwood Avenue, Boston, MA 02115, USA.
authors: Sophia
authors: S
authors: Koo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects*; D003131:Combined Modality Therapy; D000431:Ethanol / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents; D000891:Anti-Infective Agents, Local; D000431:Ethanol
keywords: biofilms; catheter-related infections; salvage therapy