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.
T. Moriuchi, None
A. Shinagawa, None
R. Niiya, None
Y. Miyaji, None
Y. Nakamura, None