A randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients - the HEALTHY-CATH trial

被引:51
作者
Broom, Jennifer K. [1 ]
Krishnasamy, Rathika [2 ]
Hawley, Carmel M. [2 ]
Playford, E. Geoffrey [3 ]
Johnson, David W. [2 ]
机构
[1] Univ Queensland, Nambour Gen Hosp, Dept Infect Dis, Nambour, Qld 4560, Australia
[2] Univ Queensland, Princess Alexandra Hosp, Dept Nephrol, Brisbane, Qld, Australia
[3] Univ Queensland, Princess Alexandra Hosp, Infect Management Serv, Brisbane, Qld, Australia
关键词
Catheter related blood stream infection (CRBSI); Central venous catheter; Ethanol; Lock therapy; Haemodialysis (HD); Prophylaxis; PEDIATRIC-PATIENTS; METAANALYSIS; BACTEREMIA; EXPOSURE;
D O I
10.1186/1471-2369-13-146
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: Tunnelled central venous dialysis catheter use is significantly limited by the occurrence of catheter-related infections. This randomised controlled trial assessed the efficacy of a 48 hour 70% ethanol lock vs heparin locks in prolonging the time to the first episode of catheter related blood stream infection (CRBSI). Methods: Patients undergoing haemodialysis (HD) via a tunnelled catheter were randomised 1: 1 to once per week ethanol locks (with two heparin locks between other dialysis sessions) vs thrice per week heparin locks. Results: Observed catheter days in the heparin (n=24) and ethanol (n=25) groups were 1814 and 3614 respectively. CRBSI occurred at a rate of 0.85 vs. 0.28 per 1000 catheter days in the heparin vs ethanol group by intention to treat analysis (incident rate ratio (IRR) for ethanol vs. heparin 0.17; 95% CI 0.02-1.63; p=0.12). Flow issues requiring catheter removal occurred at a rate of 1.6 vs 1.4 per 1000 catheter days in the heparin and ethanol groups respectively (IRR 0.85; 95% CI 0.20-3.5 p=0.82 (for ethanol vs heparin). Conclusions: Catheter survival and catheter-related blood stream infection were not significantly different but there was a trend towards a reduced rate of infection in the ethanol group. This study establishes proof of concept and will inform an adequately powered multicentre trial to definitively examine the efficacy and safety of ethanol locks as an alternative to current therapies used in the prevention of catheter-associated blood stream infections in patients dialysing with tunnelled catheters.
引用
收藏
页数:9
相关论文
共 22 条
[11]   Randomized, controlled trial of topical exit-site application of honey (Medihoney) versus Mupirocin for the prevention of catheter-associated infections in hemodialysis patients [J].
Johnson, DW ;
van Eps, C ;
Mudge, DW ;
Wiggins, KJ ;
Armstrong, K ;
Hawley, CM ;
Campbell, SB ;
Isbel, NM ;
Nimmo, GR ;
Gibbs, H .
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY, 2005, 16 (05) :1456-1462
[12]   Efficacy of ethanol locks in reducing central venous catheter infections in pediatric patients with intestinal failure [J].
Jones, Brian A. ;
Hull, Melissa A. ;
Richardson, Denise S. ;
Zurakowski, David ;
Gura, Kathleen ;
Fitzgibbons, Shimae C. ;
Duro, Debora ;
Lo, Clifford W. ;
Duggan, Christopher ;
Jaksic, Tom .
JOURNAL OF PEDIATRIC SURGERY, 2010, 45 (06) :1287-1293
[13]   Preliminary results of a phase I trial of prophylactic ethanol-lock administration to prevent mediport catheter-related bloodstream infections [J].
Kayton, Mark L. ;
Garmey, Edward G. ;
Ishill, Nicole M. ;
Cheung, Nai-Kong V. ;
Kushner, Brian H. ;
Kramer, Kim ;
Modak, Shakeel ;
Rossetto, Carol ;
Hennelly, Courtney ;
Doyle, Melissa Parra ;
Rosenberg, Shoshana ;
Santoro, Olga ;
La Quaglia, Michael P. .
JOURNAL OF PEDIATRIC SURGERY, 2010, 45 (10) :1961-1966
[14]   Preventing haemodialysis catheter-related bacteraemia with an antimicrobial lock solution: a meta-analysis of prospective randomized trials [J].
Labriola, Laura ;
Crott, Ralph ;
Jadoul, Michel .
NEPHROLOGY DIALYSIS TRANSPLANTATION, 2008, 23 (05) :1666-1672
[15]   Catheter-related bacteremia and outcome of attempted catheter salvage in patients undergoing hemodialysis [J].
Marr, KA ;
Sexton, DJ ;
Conlon, PJ ;
Corey, GR ;
Schwab, SJ ;
Kirkland, KB .
ANNALS OF INTERNAL MEDICINE, 1997, 127 (04) :275-+
[16]   Use of an ethanol lock to prevent catheter-related infections in children with short bowel syndrome [J].
Mouw, Etisabeth ;
Chessman, Katherine ;
Lesher, Aaron ;
Tagge, Edward .
JOURNAL OF PEDIATRIC SURGERY, 2008, 43 (06) :1025-1029
[17]   Sodium Citrate Versus Heparin Catheter Locks for Cuffed Central Venous Catheters: A Single-Center Randomized Controlled Trial [J].
Power, Albert ;
Duncan, Neill ;
Singh, Seema K. ;
Brown, Wendy ;
Dalby, Elizabeth ;
Edwards, Claire ;
Lynch, Kathleen ;
Prout, Virginia ;
Cairns, Tom ;
Griffith, Megan ;
McLean, Adam ;
Palmer, Andrew ;
Taube, David .
AMERICAN JOURNAL OF KIDNEY DISEASES, 2009, 53 (06) :1034-1041
[18]   Clinical effectiveness and risk of emerging resistance associated with prolonged use of antibiotic-impregnated catheters: More than 0.5 million catheter days and 7 years of clinical experience [J].
Ramos, Elizabeth R. ;
Reitzel, Ruth ;
Jiang, Ying ;
Hachem, Ray Y. ;
Chaftari, Ann Marie ;
Chemaly, Roy F. ;
Hackett, Brenda ;
Pravinkumar, S. Egbert ;
Nates, Joseph ;
Tarrand, Jeffrey J. ;
Raad, Issam I. .
CRITICAL CARE MEDICINE, 2011, 39 (02) :245-251
[19]   A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients [J].
Sanders, Joanne ;
Pithie, Alan ;
Ganly, Peter ;
Surgenor, Lois ;
Wilson, Rachel ;
Merriman, Eileen ;
Loudon, Gail ;
Judkins, Rhonda ;
Chambers, Stephen .
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY, 2008, 62 (04) :809-815
[20]  
Schulz KF, 2010, J CLIN EPIDEMIOL, V63, P834, DOI [10.1016/j.jclinepi.2010.02.005, 10.1136/bmj.c332, 10.1016/j.ijsu.2011.09.004, 10.4103/0976-500X.72352, 10.1136/bmj.c869, 10.1186/1741-7015-8-18]