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Factors predicting efficacy of ethanol lock therapy as catheter salvage strategy for pediatric catheter‐related infections
Author(s) -
AshkenaziHoffnung Liat,
Shecter Naama,
DeVries Irit,
Levy Itzhak,
Scheuerman Oded,
YardenBilavsky Havatzelet,
Bernfeld Yael,
Mor Meirav
Publication year - 2021
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.28856
Subject(s) - medicine , catheter , univariate analysis , multivariate analysis , adverse effect , salvage therapy , surgery , chemotherapy
Aim Catheter‐related infections are difficult to cure, and failure rates are high. We aimed to evaluate the efficacy and safety of ethanol lock therapy (ELT) as catheter salvage strategy in children with central‐line‐associated bloodstream infection (CLABSI), and to identify factors associated with treatment failure. Methods Data were collected of all the children who received ELT for treatment of CLABSI during 2013‐2018 due to failure of standard therapy or multiple catheter‐related infections. Univariate and multivariate analyses of risk‐factors for ELT failure were performed. Catheter salvage rates were compared to those achieved using systemic antimicrobials alone in an historical control group. Results A total of 123 ELT episodes among 95 patients were analyzed. The majority of patients had underlying hemato‐oncological disorders. Approximately half the episodes occurred in patients with implantable ports. Early and late treatment failure rates of ELT were 16% (20/123) and 7% (9/123), respectively. Overall, successful catheter salvage was achieved in 78% (96/123) of episodes, compared to 54% using systemic antimicrobials alone ( P < .001), including mycobacterium , candida , and most staphylococcus aureus infections. Adverse events were reported in 9% (11/123) of episodes and were mostly mechanical. Multivariate analysis identified four risk factors for ELT failure: Gram‐positive bacteria, elevated C‐reactive protein, signs of tunnel infection, and low absolute neutrophil counts. Conclusions Our findings support the use of ELT for catheter salvage in children with CLABSI who failed standard therapy or had multiple catheter‐related infections. The identified variables associated with ELT failure may help identify patients who can most benefit from ELT.