title: Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.
abstract: In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.).
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA iraad@mdanderson.org.
authors.forename: Issam
authors.initials: I
authors.lastname: Raad
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Chaftari
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Ramia
authors.initials: R
authors.lastname: Zakhour
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Jordan
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Zanaib
authors.initials: Z
authors.lastname: Al Hamal
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Ammar
authors.initials: A
authors.lastname: Yousif
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Kumait
authors.initials: K
authors.lastname: Garoge
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Mulanovich
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: George M
authors.initials: GM
authors.lastname: Viola
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Soha
authors.initials: S
authors.lastname: Kanj
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Egbert
authors.initials: E
authors.lastname: Pravinkumar
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Joel
authors.initials: J
authors.lastname: Rosenblatt
authors.affiliation: MD Anderson Cancer Center, Department of Infectious Diseases, Infection Control & Employee Health, Houston, Texas, USA.
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000517:prevention & control; D018441:Biofilms / Q000187:drug effects; D055499:Catheter-Related Infections / Q000188:drug therapy* / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D062905:Central Venous Catheters / Q000009:adverse effects / Q000382:microbiology*; D004492:Edetic Acid / Q000627:therapeutic use*; D000431:Ethanol / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use*; D009369:Neoplasms / Q000628:therapy; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000431:Ethanol; D004492:Edetic Acid; D008911:Minocycline