title: Comparative effectiveness of catheter salvage strategies for pediatric catheter-related bloodstream infections.
abstract: BACKGROUND
  Intravascular catheter salvage may be attempted in clinically suitable cases in pediatric patients with catheter-related bloodstream infections. The purpose of this study was to assess the effectiveness of ethanol and hydrochloric acid (HCl) locks in achieving catheter salvage through decision-analysis modeling.
  
  
  METHODS
  A Markov decision model was created to simulate catheter salvage using three management strategies: systemic antibiotics alone, antibiotics plus HCl lock, and antibiotics plus ethanol lock. One-way and two-way sensitivity analyses were performed for all model variables. Infection control rates and recurrence rates for each strategy were derived from prospective institutional data and existing pediatric literature. Costs were derived from institutional charges.
  
  
  RESULTS
  With antibiotics alone, 73% of patients would require line replacement within 100days, compared to only 31% and 19% of patients treated with HCl and ethanol lock, respectively. Incremental cost per additional catheter salvaged is $89 for HCl lock and $456 for ethanol lock. Superior efficacy of adjunct lock therapy is insensitive to changes in the anticipated duration of central access requirement and to clinically relevant variations in all model input variables.
  
  
  CONCLUSIONS
  HCl or ethanol locks are cost-effective adjuncts to systemic antibiotics for attempted catheter salvage in the setting of catheter-related bloodstream infections.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: YH9B@hscmail.mcc.virginia.edu.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: CAG3DB@hscmail.mcc.virginia.edu.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Guidry
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: BJK2U@hscmail.mcc.virginia.edu.
authors.forename: Bartholomew J
authors.initials: BJ
authors.lastname: Kane
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: EDM6K@hscmail.mcc.virginia.edu.
authors.forename: Eugene D
authors.initials: ED
authors.lastname: McGahren
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: BMR@hscmail.mcc.virginia.edu.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Rodgers
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States; Division of Acute Care Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: RWS2K@hscmail.mcc.virginia.edu.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, United States. Electronic address: SKR3F@hscmail.mcc.virginia.edu.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Rasmussen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage* / Q000191:economics; D016470:Bacteremia / Q000188:drug therapy*; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000517:prevention & control; D002408:Catheters, Indwelling / Q000382:microbiology*; D002648:Child; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D000431:Ethanol / Q000008:administration & dosage* / Q000191:economics; D006801:Humans; D006851:Hydrochloric Acid / Q000008:administration & dosage* / Q000191:economics; D008390:Markov Chains
chemical_list: D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D000431:Ethanol; D006851:Hydrochloric Acid
keywords: Catheter-related bloodstream infection; Cost-effectiveness; Decision analysis; Ethanol lock; Hydrochloric acid lock