Adjunctive management of central line-associated bloodstream infections with 70% ethanol-lock therapy

Kubiak, David W.; Gilmore, Erin T.; Buckley, M.W.; Lynch, Robert C.; Marty, Francisco M.; Koo, Sophia

doi:10.1093/jac/dku017

Cited by 14 publications

(13 citation statements)

References 16 publications

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“…Previous smaller trials have evaluated the use of ELT in patients receiving HPN to reducing the incidence of CRBSIs, especially in the pediatric population 17 . ‐ 20 One single‐center prospective trial evaluated 31 adult patients from January 2006 to August 2009 and assessed clinical outcomes before and after ELT 12 .…”

Section: Discussionmentioning

confidence: 99%

Prevention of Subsequent Catheter‐Related Bloodstream Infection Using Catheter Locks in High‐Risk Patients Receiving Home Parenteral Nutrition

Davidson

Varayil

Okano

et al. 2015

J Parenter Enteral Nutr

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Section: Discussionmentioning

confidence: 99%

Prevention of Subsequent Catheter‐Related Bloodstream Infection Using Catheter Locks in High‐Risk Patients Receiving Home Parenteral Nutrition

Davidson

Varayil

Okano

et al. 2015

J Parenter Enteral Nutr

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“…Eight of the 9 fungi were eradicated, and no patient became hemodynamically unstable during ethanol treatment therapy. Ethanol is a readily available inexpensive antiseptic agent, with broad‐spectrum bactericidal and fungicidal properties, effective by nonspecific denaturing of proteins and dissolution of lipids 84 . Ethanol is effective at eradicating biofilm‐embedded bacteria 76 , 84 .…”

Section: Prevention Strategies—ethanol Lock Therapymentioning

confidence: 99%

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

2016

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Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.

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“…18,48,49 Although ethanol has advantages, there are concerns about side effects when used as an antimicrobial lock solution, such as systemic toxicity, damage to the catheter materials and the related intraluminal obstruction and thrombosis. 43,47 Given this, it is of interest to develop new approaches, such as what we demonstrate here with guanylated polymethacrylates. Further potential uses for guanylated polymethacrylates are chemotherapy for CLBSI, in burn wounds and as coating materials to prevent biofilm formation.…”

Section: Discussionmentioning

confidence: 89%

“…Ethanol lock has recently been recommended for CLBSI caused by microorganisms with relatively low virulence (e.g. coagulasenegative staphylococci) 47 and has been studied in vitro against monomicrobial and polymicrobial biofilms formed by C. albicans or S. aureus. 18,48,49 Although ethanol has advantages, there are concerns about side effects when used as an antimicrobial lock solution, such as systemic toxicity, damage to the catheter materials and the related intraluminal obstruction and thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Searching for new strategies against polymicrobial biofilm infections: guanylated polymethacrylates kill mixed fungal/bacterial biofilms

Locock

Verma-Gaur

et al. 2015

J. Antimicrob. Chemother.

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Objectives: Biofilm-related human infections have high mortality rates due to drug resistance. Cohabitation of diverse microbes in polymicrobial biofilms is common and these infections present additional challenges for treatment compared with monomicrobial biofilms. Here, we address this therapeutic gap by assessing the potential of a new class of antimicrobial agents, guanylated polymethacrylates, in the treatment of polymicrobial biofilms built by two prominent human pathogens, the fungus Candida albicans and the bacterium Staphylococcus aureus. Methods:We used imaging and quantitative methods to test the antibiofilm efficacy of guanylated polymethacrylates, a new class of drugs that structurally mimic antimicrobial peptides. We further compared guanylated polymethacrylates with first-line antistaphylococcal and anti-Candida agents used as combinatorial therapy against polymicrobial biofilms.Results: Guanylated polymethacrylates were highly effective as a sole agent, killing both C. albicans and S. aureus when applied to established polymicrobial biofilms. Furthermore, they outperformed multiple combinations of current antimicrobial drugs, with one of the tested compounds killing 99.98% of S. aureus and 82.2% of C. albicans at a concentration of 128 mg/L. The extracellular biofilm matrix provided protection, increasing the MIC of the polymethacrylates by 2-4-fold when added to planktonic assays. Using the C. albicans bgl2DD mutant, we implicate matrix polysaccharide b-1,3 glucan in the mechanism of protection. Data for two structurally distinct polymers suggest that this mechanism could be minimized through chemical optimization of the polymer structure. Finally, we demonstrate that a potential application for these polymers is in antimicrobial lock therapy.Conclusions: Guanylated polymethacrylates are a promising lead for the development of an effective monotherapy against C. albicans/S. aureus polymicrobial biofilms.

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Adjunctive management of central line-associated bloodstream infections with 70% ethanol-lock therapy

Abstract: Adjunctive 70% ELT is an inexpensive, well-tolerated option for CVC salvage in patients with CLABSI and warrants further investigation.

Cited by 14 publications

References 16 publications

Prevention of Subsequent Catheter‐Related Bloodstream Infection Using Catheter Locks in High‐Risk Patients Receiving Home Parenteral Nutrition

Prevention of Subsequent Catheter‐Related Bloodstream Infection Using Catheter Locks in High‐Risk Patients Receiving Home Parenteral Nutrition

Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies

Searching for new strategies against polymicrobial biofilm infections: guanylated polymethacrylates kill mixed fungal/bacterial biofilms

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