Optimizing Catheter Salvage in CRBSI: Role of Alcohol Lock Therapy
Prem Varma, Abhilasha Soni, Arpit Agarwal, Geet Bajpai, Mehak SinglaBackground
Catheter-related bloodstream infection (CRBSI) is a major complication of tunneled cuffed catheters (TCCs). The Infectious Diseases Society of America (IDSA) recommends systemic antibiotics with antibiotic lock therapy as standard treatment for CRBSI. Guidelines recommend catheter removal in cases of non-resolving infection, especially if the offending organism is Staphylococcus , Pseudomonas , or a fungus, thus adding significant morbidity.
Materials and Methods
This 5-year prospective study included patients with chronic kidney disease (CKD) stage 5 on hemodialysis (HD), with definite CRBSI, treated with either alcohol lock or antibiotic lock therapy in addition to systemic antibiotics. The patients were followed up to resolution of infection, catheter removal or death, with the primary outcome of rate of catheter loss.
Results
87 episodes of CRBSI (1.78 per 1000 catheter days) were observed, with the mean time to CRBSI of 169 + 177.80 days. With antibiotic lock, catheter loss occurred in 68.2% (15/22), while with alcohol lock therapy, catheter removal was required in 12.3% (8/65) ( p <0.001).
Conclusion
70% alcohol lock solution appears to be an effective strategy for catheter salvage in patients with CRBSI, achieving salvaging of 87.7% of TCCs