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Kidney Week

Abstract: FR-PO482

Should Alcohol Lock Replace Antibiotic Lock in Catheter-Related Bloodstream Infection (CRBSI) Management?

Session Information

  • Dialysis: Vascular Access
    November 03, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

  • 803 Dialysis: Vascular Access

Authors

  • Varma, Prem P., Primus Super Speciality Hospital, Chanakyapuri, Delhi, India
  • Singla, Mehak, Primus Super Speciality Hospital, Chanakyapuri, Delhi, India
Background

Catheter related blood stream Infection (CRBSI) is a dreaded complication of Tunneled Cuffed Catheter (TCC), with a reported incidence of 1.1- 5.5 episodes/1000 catheter days. Patients with Staphylococcus aureus, Pseudomonas aeruginosa or fungal growth generally require catheter removal. As per the KDOQI clinical practice guideline for vascular access: 2019, Systemic antibiotics plus antibiotic lock is the current standard of care for CRBSI.This study was done to find the usefulness of 70% alcohol lock (in place of antibiotic lock) in patients with established CRBSI.

Methods

All dialysis patients with TCC as vascular access were the subjects of the study. As per our center’s protocol, all patients were given heparin lock after each session of dialysis. CRBSI was diagnosed as per CDC/IDSA criteria. In patients with CRBSI, 70 % alcohol lock (2 ml in each port) was given for 3 consecutive days, in addition to systemic antibiotics. Outcome of these patients was studied and compared with retrospective controls, who were given 'antibiotic lock with systemic antibiotics'.

Results

Over the last two- years 188 TCCs were placed in 181 patients at our center. Our CRBSI rate was 1.38/1000 catheter days. We encountered 31 episodes of CRBSI in 23 patients. There were 16 males and 7 females, with mean age of 57.03 +11.65 years. Presentation was with fever and chills in 80.6% and hemodynamic compromise in 20%. Relevant investigations showed raised leucocyte count in 23 (74.1%) and procalcitonin in 27 (87%) episodes. The etiological agents were gram positive organisms in 12 (38.7%) and gram negative infections in 19 (61%) episodes ; Staphylococcus aureus was isolated in 11 and albus in 1, Pseudomonas aeruginosa in 6, Klebsiella pneumonie in 8, citrobacter in 3 and E coli in 2 episodes. Only 4 cases required catheter removal. Over a mean follow up period of 145 days after alcohol lock, all catheter have been functioning well. On comparison with our retrospective data of 22 patients with CRBSI who were given antibiotic lock, 15 required catheter removal. The differeence in catheter salvage is statistically significant (p<0.001). Our study shows that alcohol lock with systemic antibiotics works as panacea.

Conclusion

Our single center data suggests that alcohol lock works wonder in the management of CRBSI and can be included in the current standard of care.