title: Efficacy of ethanol locks to reduce the incidence of catheter-related bloodstream infections for home parenteral nutrition pediatric patients: comparison of therapeutic treatment with prophylactic treatment.
abstract: OBJECTIVE
  Children with intestinal failure (IF) requiring central venous catheters (CVCs) often experience frequent catheter-related bloodstream infections (CRBSIs), which is a serious and life-threatening complication. To reduce the incidence of CRBSI, prophylactic ethanol lock therapy (ELT) was initiated.
  
  
  METHODS
  Patients with IF received home parenteral nutrition via a silicone tunneled CVC. All of them had received therapeutic ELT from January 2009 (first period) and prophylactic ELT from December 2012 (second period). Prophylactic ELT refers to ethanol lock for 2 h during the monthly hospital visit. We compared the CRBSI rate and number of CVC replacements between both periods.
  
  
  RESULTS
  Four patients received 19 CVCs for a total of 5623 catheter days. In the first period, there were 12 CRBSIs in 1823 catheter days (rate 6.77 per 1000 catheter days). In the second period, there were 9 CRBSIs in 3800 catheter days (rate 3.13 per 1000 catheter days). Overall, the rate of CVC replacement decreased from 4.92 to 1.72 per 1000 catheter days (p = 0.04). No adverse reactions were experienced during ethanol instillation.
  
  
  CONCLUSIONS
  Monthly prophylactic ELT for IF patients is considered to be a safe and effective modality for reducing the replacement of CVCs due to CRBSIs.
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Kawano
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Tatsuru
authors.initials: T
authors.lastname: Kaji
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Shun
authors.initials: S
authors.lastname: Onishi
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Waka
authors.initials: W
authors.lastname: Yamada
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakame
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Mukai
authors.affiliation: Department of Pediatric Surgery, Research Field in Medicine and Health Sciences, Medical and Dental Sciences Area, Research and Education Assembly, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima City, 890-8520, Japan. sieiri@m.kufm.kagoshima-u.ac.jp.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Ieiri
mesh_terms: D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002404:Catheterization / Q000706:statistics & numerical data; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D002675:Child, Preschool; D000431:Ethanol / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016331:Parenteral Nutrition, Home
chemical_list: D000891:Anti-Infective Agents, Local; D000431:Ethanol
keywords: Catheter-related bloodstream infection; Ethanol lock therapy; Intestinal failure; Pediatric patients