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Ethanol lock therapy

Guillermo Ares, Catherine J Hunter
PURPOSE OF REVIEW: Central venous catheters (CVCs) have a prominent role in the diagnostic and therapy of neonates and children. Herein, we describe the multiple indications for CVC use and the different devices available for central venous access. Given the prevalent use of CVCs, healthcare systems are focused on reducing complications from their use, particularly central line-associated bloodstream infections (CLABSIs). The most up-to-date information available sheds light on best practices and future areas of investigation...
March 18, 2017: Current Opinion in Pediatrics
Masato Kimura, Eichiro Kawai, Hisao Yaoita, Natsuko Ichinoi, Osamu Sakamoto, Shigeo Kure
Kocuria kristinae is a catalase-positive, coagulase-negative, Gram-positive coccus found in the environment and in normal skin and mucosa in humans; however, it is rarely isolated from clinical specimens and is considered a nonpathogenic bacterium. We describe a case of catheter-related bacteremia due to K. kristinae in a young adult with propionic acidemia undergoing periodic hemodialysis. The patient had a central venous catheter implanted for total parenteral nutrition approximately 6 months prior to the onset of symptoms because of repeated acute pancreatitis...
2017: Case Reports in Infectious Diseases
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September 2016: Gastroenterology Nursing: the Official Journal of the Society of Gastroenterology Nurses and Associates
Sheila L Robbins Tighe
Patients with intestinal failure have an increased risk for catheter-related bloodstream infections that can necessitate central venous line replacement and result in morbidity, prolonged hospitalization, or mortality. For pediatric patients with intestinal failure, the severe loss of intestinal absorptive ability leads to reliance on parenteral nutrition to meet minimal needs required for growth and development. Reliance on parenteral nutrition, in turn, forces dependency on central venous lines. Recent research concentrating on the pediatric population with intestinal failure indicates that prophylactic ethanol lock therapy can reduce the rate of catheter-related bloodstream infections and decrease central venous line removal rates in this high-risk population...
September 2016: Gastroenterology Nursing: the Official Journal of the Society of Gastroenterology Nurses and Associates
Takafumi Kawano, Tatsuru Kaji, Shun Onishi, Koji Yamada, Waka Yamada, Kazuhiko Nakame, Motoi Mukai, Satoshi Ieiri
PURPOSE: Children with intestinal failure (IF) requiring central venous catheters (CVCs) often experience frequent catheter-related bloodstream infections (CRBSIs), which is a serious and life-threatening complication. To reduce the incidence of CRBSI, prophylactic ethanol lock therapy (ELT) was initiated. METHODS: Patients with IF received home parenteral nutrition via a silicone tunneled CVC. All of them had received therapeutic ELT from January 2009 (first period) and prophylactic ELT from December 2012 (second period)...
September 2016: Pediatric Surgery International
Livia Lown, Brian M Peters, Carla J Walraven, Mairi C Noverr, Samuel A Lee
Candida albicans is a major cause of catheter-related bloodstream infections and is associated with high morbidity and mortality. Due to the propensity of C. albicans to form drug-resistant biofilms, the current standard of care includes catheter removal; however, reinsertion may be technically challenging or risky. Prolonged exposure of an antifungal lock solution within the catheter in conjunction with systemic therapy has been experimentally attempted for catheter salvage. Previously, we demonstrated excellent in vitro activity of micafungin, ethanol, and high-dose doxycycline as single agents for prevention and treatment of C...
2016: PloS One
Ying Wang, Jessica N Ivany, Vlado Perkovic, Martin P Gallagher, Mark Woodward, Meg J Jardine
BACKGROUND: Catheter malfunction, including thrombosis, is associated with reduced dialysis adequacy, as well as an increased risk of catheter-related bacteraemia and mortality. The role of anticoagulants in the prevention of catheter malfunction remains uncertain. OBJECTIVES: This review aimed to compare the prophylactic effect of different anticoagulant agents, preparations, doses and administration on the incidence of central venous haemodialysis catheter-related malfunction and sepsis in patients with end-stage kidney disease (ESKD)...
April 4, 2016: Cochrane Database of Systematic Reviews
Issam Raad, Anne-Marie Chaftari, Ramia Zakhour, Mary Jordan, Zanaib Al Hamal, Ying Jiang, Ammar Yousif, Kumait Garoge, Victor Mulanovich, George M Viola, Soha Kanj, Egbert Pravinkumar, Joel Rosenblatt, Ray Hachem
In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted...
June 2016: Antimicrobial Agents and Chemotherapy
S Hogan, M Zapotoczna, N T Stevens, H Humphreys, J P O'Gara, E O'Neill
Infection of intravascular catheters by Staphylococcus aureus is a significant risk factor within the health care setting. To treat these infections and attempt salvage of an intravascular catheter, antimicrobial lock solutions (ALSs) are being increasingly used. However, the most effective ALSs against these biofilm-mediated infections have yet to be determined, and clinical practice varies greatly. The purpose of this study was to evaluate and compare the efficacies of antibiotics and antiseptics in current clinical use against biofilms produced by reference and clinical isolates of S...
May 2016: Antimicrobial Agents and Chemotherapy
Ethan A Mezoff, Lin Fei, Misty Troutt, Kim Klotz, Samuel A Kocoshis, Conrad R Cole
BACKGROUND: Prophylactic ethanol lock therapy (ELT) reduces central line-associated bloodstream infections (CLA-BSIs) in children with intestinal failure (IF). However, the risk of associated complications is unclear. We aim to describe our experience with prophylactic ethanol locks in a cohort of patients with IF. MATERIALS AND METHODS: Thirty patients on ELT from 2010-2013 were identified by review of our intestinal rehabilitation registry. Patient demographics, CLA-BSI events, and line complications were extracted...
August 2016: JPEN. Journal of Parenteral and Enteral Nutrition
Yinin Hu, Christopher A Guidry, Bartholomew J Kane, Eugene D McGahren, Bradley M Rodgers, Robert G Sawyer, Sara K Rasmussen
BACKGROUND: Intravascular catheter salvage may be attempted in clinically suitable cases in pediatric patients with catheter-related bloodstream infections. The purpose of this study was to assess the effectiveness of ethanol and hydrochloric acid (HCl) locks in achieving catheter salvage through decision-analysis modeling. METHODS: A Markov decision model was created to simulate catheter salvage using three management strategies: systemic antibiotics alone, antibiotics plus HCl lock, and antibiotics plus ethanol lock...
February 2016: Journal of Pediatric Surgery
Kristine Opsvik Wikene, Ellen Bruzell, Hanne Hjorth Tønnesen
Natural deep eutectic solvents (NADES) are a novel class of eutectics which show a unique potential as solubilizer of water insoluble compounds. The purpose of the current study was to evaluate the potential of NADES as a solvent for the hydrophobic photosensitizer curcumin for use in antimicrobial photodynamic therapy (aPDT). Two of the seventeen NADES initially prepared (i.e., NADES GS and MC3) solubilized >0.05mg/ml curcumin and were further characterized. The hydrolytic stability (i.e., t1/2) of curcumin in NADES was comparable to or up to 2-10 times higher than previously reported results in cyclodextrins and up to >1300 times higher than results reported in buffer at pH8...
December 1, 2015: European Journal of Pharmaceutical Sciences
Jacob B Davidson, Jithinraj Edakkanambeth Varayil, Akiko Okano, Jennifer A Whitaker, Sara L Bonnes, Darlene G Kelly, Manpreet S Mundi, Ryan T Hurt
INTRODUCTION: Catheter-related bloodstream infection (CRBSI) is a serious complication in patients receiving home parenteral nutrition (HPN). Antibiotic lock therapy (ALT) and ethanol lock therapy (ELT) can be used to prevent CRBSI episodes in high-risk patients. METHODS: Following institutional review board approval, all patients enrolled in the Mayo Clinic HPN program from January 1, 2006, to December 31, 2013, with catheter locking were eligible to be included...
September 2, 2015: JPEN. Journal of Parenteral and Enteral Nutrition
Jennifer Colvine, Patti Thomson, Donald R Duerksen
We report the use of ethanol lock therapy to dramatically reduce the incidence of catheter-related bloodstream infections (CRBSIs) in a long-term adult home parenteral nutrition (HPN) patient. This case study demonstrates the efficacy of ethanol lock therapy in eliminating CRBSIs when other treatments have been unsuccessful. We suggest that ethanol lock therapy has an important role in decreasing CRBSI in HPN patients with recurrent CRBSIs.
August 21, 2015: JPEN. Journal of Parenteral and Enteral Nutrition
Hamid Tayebi Khosroshahi, Hosein Mahdipur, Sahar Parkhideh, Saiid Basmenji, Mohammadreza Khalilzadeh, Majid Tozihi
Bacterial overgrowth in the inner layer of the catheter as a biofilm is highly encountered in routine medical care, and it may occur in a few days after inserting a catheter as an access in hemodialysis (HD) patients. Catheter-induced bacteremia is often due to the development of biofilms. Locking catheters with antimicrobial agents is an effective way of reducing the risk of catheter-related infection. In a controlled, randomized clinical trial, 64 chronic HD patients (32 men and 32 women with a mean age of 57...
May 2015: Saudi Journal of Kidney Diseases and Transplantation
Wendy K Fujioka, Robert A Cowles
BACKGROUND: Serial transverse enteroplasty (STEP) lengthens and tapers dilated small bowel in patients with short bowel syndrome (SBS). Previous reports document encouraging outcomes with regard to tolerance for enteral nutrition (EN) and complications appear related to the re-operative nature of many cases and to the presence of multiple staple lines. However, infectious complications following STEP have not been examined. Since infections, especially catheter-related blood stream infections (CRBSI), are considered detrimental in infants and children with SBS, we sought to define the frequency and outcomes of peri-operative infections associated with STEP...
March 2015: Journal of Pediatric Surgery
Bertrand Souweine, Alexandre Lautrette, Didier Gruson, Emmanuel Canet, Kada Klouche, Laurent Argaud, Julien Bohe, Maïté Garrouste-Orgeas, Christophe Mariat, François Vincent, Sophie Cayot, Olivier Cointault, Alain Lepape, Dominique Guelon, Michael Darmon, Aurélien Vesin, Nicolas Caillot, Carole Schwebel, Alexandre Boyer, Elie Azoulay, Lila Bouadma, Jean-François Timsit
RATIONALE: Ethanol rapidly eradicated experimental biofilm. Clinical studies of ethanol lock to prevent catheter-related infections (CRIs) suggest preventive efficacy. No such studies have been done in intensive care units (ICU). OBJECTIVES: To determine whether ethanol lock decreases the risk of major CRI in patients with short-term dialysis catheters (DCs). METHODS: A randomized, double-blind, placebo-controlled trial was performed in 16 ICUs in seven university hospitals and one general hospital in France between June 2009 and December 2011...
May 1, 2015: American Journal of Respiratory and Critical Care Medicine
Matteo Vassallo, Brigitte Dunais, Pierre-Marie Roger
PURPOSE: Antimicrobial lock therapy (ALT) seems a promising approach for treatment of central line associated bloodstream infections (CLABSI). The recent introduction of molecules such as daptomycin and tigecycline, alone or in combination with other molecules, improved chances of efficacy of ALT, due to their activity on the bacterial biofilm. Our aim was to review the literature concerning ALT for CLABSI, including data concerning novel molecules. METHODS: We included case-control studies evaluating two or more molecules as ALT in central venous catheter infections extracted from the Medline database...
August 2015: Infection
Rebecca F Chhim, Catherine M Crill, Hailey K Collier, Sandra R Arnold, Massroor Pourcyrous, Bernd Meibohm, Michael Christensen
BACKGROUND: Ethanol lock therapy (ELT) has emerged as an effective method for the prevention and treatment of central line-associated bloodstream infections (CLABSIs), but the safety of ELT in infants has not been established. OBJECTIVE: The objective of this study was to determine blood alcohol concentration (BAC) and evidence of hepatic injury in infants after infusing a small one-time dose of ethanol, equivalent to the volume that would be flushed through the central venous catheter (CVC) after ELT is completed...
April 2015: Annals of Pharmacotherapy
Kareem Abu-Elmagd
In the 1990s, the introduction of visceral transplantation fuelled interest in other innovative therapeutic modalities for gut rehabilitation. Ethanol lock and omega-3 lipid formulations were introduced to reduce the risks associated with total parenteral nutrition (TPN). Autologous surgical reconstruction and bowel lengthening have been increasingly utilized for patients with complex abdominal pathology and short-bowel syndrome. Glucagon-like peptide 2 analogue, along with growth hormone, are available to enhance gut adaptation and achieve nutritional autonomy...
February 2015: Nature Reviews. Gastroenterology & Hepatology
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