Research in context
Evidence before this study
We searched PubMed for studies published between inception and Sept 21, 2017 with the terms central venous catheter* AND infection* AND ethanol OR alcohol. We reviewed all reports that described the use of single-agent ethanol as lock therapy to treat or prevent central line-associated bloodstream infection (CLABSI) in any human population. We identified additional relevant articles from reference lists. 28 articles described the use of ethanol lock therapy as primary prophylaxis, of which nine were controlled trials. In controlled studies, the reported efficacy of prophylaxis with ethanol lock therapy ranged from a non-significant 300% increase in treatment failure to a 91% reduction. In the only controlled trial performed in children with cancer, there was a significant 45% reduction in the risk of CLABSI. 19 articles described the use of ethanol lock therapy for treatment of CLABSI, of which one was a controlled trial performed in patients receiving haemodialysis. This controlled trial showed a significant 79% reduction in the risk of treatment failure. There was one observational study in children with cancer, which showed a non-significant 38% reduction in treatment failure. Reported adverse effects of ethanol lock therapy included infusion reactions and catheter occlusion. We found no controlled studies of the use of ethanol lock therapy as treatment and secondary prophylaxis for CLABSI.
Added value of this study
Our findings showed that treatment and secondary prophylaxis with ethanol lock therapy for CLABSI in children with cancer or haematological disorders was not effective and that such therapy increased the risk of catheter occlusion requiring thrombolytic therapy.
Implications of all the available evidence
There is no high-quality evidence to support the use of ethanol lock therapy as treatment or secondary prophylaxis for CLABSI in children with cancer or haematological disorders, and the regimen tested in this study was both ineffective and associated with adverse effects. Other populations and some subgroups might benefit from ethanol lock therapy as treatment or secondary prophylaxis for CLABSI, but it should not be used routinely in children with cancer or haematological disorders.