670. Evaluation of 70% ethanol lock therapy (ELT) for treatment of catheter-related bloodstream infection (CRBSI)
Session: Poster Abstract Session: Preventing Catheter Associated Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: Ethanol is bactericidal against most pathogens implicated in CRBSI and penetrates biofilms well. Current IDSA guidelines cite insufficient evidence to support adjunctive ELT for catheter salvage in patients with CRBSI in combination with systemic antimicrobials. We evaluated the efficacy and safety of 70% ELT for CRBSI at our institution after implementation of a hospital ETL protocol.

Methods: We collected data on all patients treated with adjunctive ELT for CRBSI for catheter salvage from 9/09 to 3/11 and assessed clinical outcomes and adverse events.

Results: 43 patients received ELT for 50 discrete CRBSI episodes. Median age was 49 years (range 22, 79) and 26 (60%) were female. 33 (77%) had an underlying malignancy, and 28 (65%) patients primarily required a central venous catheter (CVC) for chemotherapy, 7 (16%) total parenteral nutrition, 4 (9%) parenteral medications, and 4 (9%) blood products. 21 (49%) had a tunneled CVC, 18 (42%) a subcutaneously implanted port, 3 (7%) a peripherally inserted central catheter, 1 (2%) both a tunneled CVC and a port. Of 50 CRBSI episodes, 23 (46%) were due to coagulase-negative staphylococci, 8 (16%) Gram negative rods, 3 (6%) Enterococcus faecium, 2 (4%) Staphylococcus aureus, 4 (8%) other pathogens, and 10 (20%) by two concurrent microbes. Patients were bacteremic for a median of 3 days (range 1, 13) before starting ELT. Patients received a median of 4 days (range 1, 21) of ELT, with systemic antibiotics active against their causative organism. 38 (76%) cleared their blood cultures prior to initiation of ELT, 3 (6%) on the ELT start date, 4 (8%) 1 day after starting ELT, and the remainder a median of 5 days after starting ELT. CVCs were removed in 17 (34%) CRBSI episodes, but only a median of 2 days (range 1, 28) after starting ELT. Of 24 patients with ≥ 5 days of ELT, 2 (8%) underwent CVC removal 5 and 10 days after starting ELT—one cleared their cultures; the other had persistent Bacillus cereus bacteremia despite 7 days of ELT and antibiotics. No patients had recrudescent bacteremia after ELT. One patient had temporary CVC occlusion potentially related to ELT; otherwise, ELT was tolerated without any apparent adverse effects.

Conclusion: 70% ELT for catheter salvage appeared to be safe and effective in our patients with CRBSI.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

David Kubiak, PharmD1,2, Erin Gilmore, MA1, Mary Buckley, BS1, Robert Lynch, AB1, Francisco Marty, MD1,2,3 and Sophia Koo, MD1,2,3, (1)Brigham and Women's Hospital, Boston, MA, (2)Dana-Farber Cancer Institute, Boston, MA, (3)Harvard Medical School, Boston, MA

Disclosures:

D. Kubiak, None

E. Gilmore, None

M. Buckley, None

R. Lynch, None

F. Marty, None

S. Koo, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.