title: Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial.
abstract: BACKGROUND
  Ethanol rapidly eradicated experimental biofilm. Clinical studies of ethanol lock to prevent catheter-related infections (CRIs) suggest preventive efficacy. No such studies have been done in intensive care units (ICU).
  
  
  OBJECTIVE
  To determine whether ethanol lock decreases the risk of major CRI in patients with short-term dialysis catheters (DCs).
  
  
  METHODS
  A randomized, double-blind, placebo-controlled trial was performed in 16 ICUs in seven university hospitals and one general hospital in France between June 2009 and December 2011. Adults with insertion of a nontunneled, nonantimicrobial-impregnated double-lumen DC for an expected duration greater than 48 hours, to perform renal-replacement therapy or plasma exchange, were randomly allocated (1:1) to receive a 2-minute catheter lock with either 60% wt/wt ethanol solution (ethanol group) or 0.9% saline solution (control group) at the end of DC insertion and after each renal-replacement therapy or plasma exchange session. The main outcome was major CRI defined as either catheter-related clinical sepsis without bloodstream infection or catheter-related bloodstream infection during the ICU stay.
  
  
  RESULTS
  The intent-to-treat analysis included 1,460 patients (2,172 catheters, 12,944 catheter-days, and 8,442 study locks). Median DC duration was 4 days (interquartile range, 2-8) and was similar in both groups. Major CRI incidence did not differ between the ethanol and control groups (3.83 vs. 2.64 per 1,000 catheter-days, respectively; hazard ratio, 1.55; 95% confidence interval, 0.83-2.87; P = 0.17). No significant differences occurred for catheter colonization (P = 0.57) or catheter-related bloodstream infection (P = 0.99).
  
  
  CONCLUSIONS
  A 2-minute ethanol lock does not decrease the frequency of infection of DCs in ICU patients. Clinical trial registered with www.clinicaltrials.gov (NCT 00875069).
authors: 1 Medical Intensive Care Unit and.
authors: Bertrand
authors: B
authors: Souweine
authors: Alexandre
authors: A
authors: Lautrette
authors: Didier
authors: D
authors: Gruson
authors: Emmanuel
authors: E
authors: Canet
authors: Kada
authors: K
authors: Klouche
authors: Laurent
authors: L
authors: Argaud
authors: Julien
authors: J
authors: Bohe
authors: Maïté
authors: M
authors: Garrouste-Orgeas
authors: Christophe
authors: C
authors: Mariat
authors: François
authors: F
authors: Vincent
authors: Sophie
authors: S
authors: Cayot
authors: Olivier
authors: O
authors: Cointault
authors: Alain
authors: A
authors: Lepape
authors: Dominique
authors: D
authors: Guelon
authors: Michael
authors: M
authors: Darmon
authors: Aurélien
authors: A
authors: Vesin
authors: Nicolas
authors: N
authors: Caillot
authors: Carole
authors: C
authors: Schwebel
authors: Alexandre
authors: A
authors: Boyer
authors: Elie
authors: E
authors: Azoulay
authors: Lila
authors: L
authors: Bouadma
authors: Jean-François
authors: JF
authors: Timsit
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000494:pharmacology*; D055499:Catheter-Related Infections / Q000209:etiology* / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness; D004311:Double-Blind Method; D000431:Ethanol / Q000494:pharmacology*; D005260:Female; D005602:France; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis
chemical_list: D000890:Anti-Infective Agents; D000431:Ethanol
keywords: catheter-related infection; dialysis catheter; ethanol; prevention; renal-replacement therapy