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JAC Advance Access published online on July 11, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn284
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients

Joanne Sanders1,2, Alan Pithie3,*, Peter Ganly1,2, Lois Surgenor4, Rachel Wilson5, Eileen Merriman2, Gail Loudon2, Rhonda Judkins2 and Stephen Chambers1,3

1 Department of Pathology, Christchurch School of Medicine and Health Sciences, Otago University, Christchurch, New Zealand 2 Department of Clinical Haematology, Christchurch Hospital, Christchurch, New Zealand 3 Department of Infectious Diseases, Christchurch Hospital, Christchurch, New Zealand 4 Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Otago University, Christchurch, New Zealand 5 Pharmacy Department, Christchurch Hospital, Christchurch, New Zealand

Received 8 April 2008; returned 8 May 2008; revised 6 June 2008; accepted 11 June 2008

* Corresponding author. Tel: +64-33640640; Fax: +64-33640064; E-mail: alan.pithie{at}cdhb.govt.nz

Objectives: The aim of this study was to prospectively evaluate the use of intraluminal ethanol for the prevention of catheter-associated bloodstream infection (CABSI) in immunosuppressed haematology patients.

Patients and methods: Patients receiving chemotherapy for haematological malignancy or haematopoietic cell transplantation were randomized in a double-blinded manner to receive either intraluminal 70% ethanol/water or heparinized saline locks on a daily basis throughout a prophylactic treatment period. The primary endpoint was an episode of CABSI (defined as ‘bacteraemia in a febrile patient with a central venous catheter that was in use within the preceding 48 h and with no other identified focus of infection’). The trial was registered with the Australian Clinical Trials Register: number ACTRN012605000383662.

Results: There were 34 and 30 prophylactic treatment periods in the ethanol and control groups, respectively. CABSI occurred in 3 (9%, 0.60/100 catheter-days) and 11 (37%, 3.11/100 catheter-days) prophylactic treatment periods in the ethanol and control groups, respectively (OR = 0.18, 95% CI 0.05–0.65, P = 0.008). Eleven (32%) and 5 (17%) patients in the ethanol and control groups, respectively, remained afebrile throughout the prophylactic treatment (P = 0.18).

Conclusions: The daily administration of ethanol locks into lumens of central venous catheters effectively reduces the incidence of CABSI.

Key Words: catheter-related infections , ethanol , RCTs , CABSI


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