In cancer patients with long-term catheters, removal of the CVC and reinsertion of a new catheter at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies conducted by our group showed that M-EDTA-ETOH lock may eradicate microbial organisms embedded in biofilm on a catheter surface and, hence, enabling the treatment of CLABSI while retaining the infected catheter in situ .
Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective, open-label, single-institution pilot study at our center and compare to a historical group of 60 patients with CLABSI whose CVC was removed. Eligible patients were aged ≥18 years, with CLABSI as defined by CDC. Each catheter lumen was locked with M-EDTA/ETOH solution for 2 hours administered once daily for a total of 7 doses.
Patients who received locks had comparable clinical characteristics to the control group in terms of age, type of cancer, degree of neutropenia, type of causative organism, ICU admission and systemic antibiotic therapy. CLABSI was successfully treated in all patients who received lock . Time to fever resolution and microbiological eradication was similar in both groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy compared to patients who had their CVC removed (median 11 days vs 16 days; P<0.0001). They were able to retain their CVC for a median duration of 61 days (range 2-237) after initiation of lock therapy compared to the median of 2 (1-8) days in the control group (p<0.0001. Overall complications that included mechanical and infectious complications were significantly higher in the control compared to those who received the lock intervention (11 vs. 0; P=0.014).
M-EDTA/ETOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to the CVC removal. This improved outcome occurred despite the fact that the lock versus CVC removal group received a shorter duration of appropriate systemic antimicrobial therapy. A large Phase III prospective, randomized trial is necessary to demonstrate the efficacy of this intervention.
UT MD Anderson Cancer Center:
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R. Zakhour, None
A. Yousif, None
Y. Jiang, None
M. Jordan, None
Z. Al Hamal, None
G. M. Viola, None
M. Fisch, None
R. Hachem, None