284. Short Dwell Time Ethanol Lock Therapy for Central Line-associated Bloodstream Infection in Children
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDSA SanDiego ELT 2015 final.pdf (761.6 kB)
  • Background: Central venous catheters (CVCs) are commonly used in pediatric patients who need a continuous venous access. Central Line-associated Bloodstream Infection (CLABSI) is a serious complication in these children and a cause of catheter replacement. We previously reported the safety and efficacy of ethanol lock therapy (ELT) for children with CLABSI. However, a limitation of our study was small sample size. To investigate the safety and efficacy of ELT, we continued the study and added the cases. 

    Methods: Between April, 2012 and April, 2015, pediatric patients diagnosed CLABSI at the St. Marianna University Hospital in Kawasaki, Japan were enrolled. They were all under 20 years of age and almost of them were used broviac-type tunneled CVCs. They were treated with instillation of 70% ethanol lock with a dwell time of 4 hours per day. Duration of ELT was 5 days from blood cultures were confirmed completely negative. CVCs were allowed ongoing utilization for venous access if they were needed. The definition of successful ELT required negative blood cultures taken from all lumens of CVCs within 3 days from ELT started and no subsequent isolation of the original organism from blood cultures with retention of the CVCs for 30 days. 

    Results: During the observation period, 22 patients were treated for CLABSI with ELT. The median age was 10.8 years (IQR: 6-15.9 years). The organisms that cause CLABSI include S. epidermidis (n=9), S. hominis (n=3), S. warneri (n=2), S. saprophyticus (n=1), S. haemolyticus (n=1), S. capitis (n=1), S. aureus (n=1), E. faecalis (n=1), Serratia marcescens (n=1) and other coagulase-negative staphylococci (n=2). Twenty of 22 (91%) patients completed ELT and retained their CVCs for 30 days. Two cases (9%) were continued culture positive for over 3 days with S. epidermidisand failed to complete the ELT. There was no significant adverse event with ELT.

    Conclusion: Our study suggested that ELT was a safe and efficacious method in treating CLABSI avoiding removal of CVCs in pediatric patients even though that induced short dwell time of 4 hours per day and allowed ongoing utilization for venous access. A larger study is necessary in the future to validate these findings.

    Tomohiro Katsuta, MD, PhD, Rei Fumimoto, MD, Takumi Moriuchi, MD, Ayano Shinagawa, MD, Ryo Niiya, MD, Yusuke Miyaji, MD, PhD and Yukitsugu Nakamura, MD, PhD, Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan

    Disclosures:

    T. Katsuta, None

    R. Fumimoto, None

    T. Moriuchi, None

    A. Shinagawa, None

    R. Niiya, None

    Y. Miyaji, None

    Y. Nakamura, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.