title: A comparison of two methods of treatment for catheter-related bloodstream infections in patients on home parenteral nutrition.
abstract: OBJECTIVE
  Home parenteral nutrition (HPN) enables patients who cannot eat normally to survive and function. Catheter-related bloodstream infections (CRBSIs) are the most dangerous complication, which may be fatal if left untreated or if treatment is delayed. For over 20 years CRBSIs were managed by catheter removal and implantation of a new one after completion of antibiotic treatment. However, frequent catheter replacements put the patient at risk of large vein thrombosis, which may render parenteral nutrition impossible. The management of CRBSIs evolved into antibiotic treatment without catheter removal. The effectiveness of this approach was, however, limited by the low penetration of the antibiotics into the biofilm. Filling catheters with concentrated ethanol destroys the biofilm and does not result in the emergence of drug resistance. The aim of our study was to assess the remote outcomes of CRBSI treatment using two approaches: antibiotic-ethanol lock therapy and catheter replacement.
  
  
  METHODS
  We retrospectively analysed the treatment outcomes of CRBSI diagnosed and managed in HPN patients. During the analysed period, a total of 428 patients between 13 and 96 years of age were on HPN and a total of 181 of them suffered a total of 352 CRBSI episodes managed with one of the two approaches.
  
  
  RESULTS
  We showed no significant differences between the two approaches in terms of survival likelihood or duration of catheter use after an episode of CRBSI caused by various bacterial species.
  
  
  CONCLUSIONS
  The use of antibiotic-ethanol lock therapy in the management of CRBSI is equally effective as catheter replacement.
authors.affiliation: Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland. Electronic address: michal-lawinski@wp.pl.
authors.forename: Michał
authors.initials: M
authors.lastname: Ławiński
authors.affiliation: Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland.
authors.forename: Krystyna
authors.initials: K
authors.lastname: Majewska
authors.affiliation: Interdisciplinary Center for Applied Cognitive Studies, University of Social Sciences and Humanities, Chodakowska 19/31, 03-815 Warsaw, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Gradowski
authors.affiliation: Department of General Surgery and Clinical Nutrition, Medical University of Warsaw, Żwirki i Wigury 61, 02-091 Warsaw, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Fołtyn
authors.affiliation: General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, 49100 Petah Tikva, Israel.
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000209:etiology; D000431:Ethanol / Q000494:pharmacology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016331:Parenteral Nutrition, Home / Q000009:adverse effects*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000431:Ethanol
keywords: Antibiotic-ethanol lock therapy; CRBSI; HPN