Reduction of central venous catheter-associated bloodstream infections in pediatric oncology patients using 70% ethanol locks: a randomized controlled multi-center trial

Background and Aims The prevention of central venous catheter‐ (CVC‐) associated bloodstream infection (CABSI) in pediatric oncology patients is essential. Ethanol locks can eliminate biofilm embedded pathogens and have no known microbial resistance. Objective To determine whether 70% ethanol locks can cause a 50% reduction in CABSI in pediatric oncology patients. Methods We conducted a randomized, double blind, multicenter trial in pediatric oncology patients (1‐18 years) with newly inserted CVCs. Patients were randomly assigned to receive 2 h ethanol locks (3 ml 70% ) or heparin locks (3 ml 100 IU/ml), maximum frequency once weekly. Primary outcomes were catheter‐associated bloodstream infection (CABSI), catheter removal or death due to CABSI. Results We included 307 patients, 153 were allocated to ethanol and 154 to heparin locks. In the ethanol group 16/153 (10% ) patients were diagnosed with CABSI versus 29/154 (19% ) in the heparin group; incidence was 0.77/1,000 and 1.46/1,000 catheter days respectively (p=0.04), resulting in a number‐needed‐to‐treat of 12 patients. Particularly Gram‐positive CABSIs (ethanol, N=8; heparin, N=21, p=0.01) were reduced. Less CVCs were removed because of CABSI in the ethanol group (ethanol, N=5; heparin, N=12, p=0.08). No patients died because of CABSI. During ethanol locks patients experienced significantly more transient symptoms compared to heparin locks (maximum grade 2) (nausea; p= 0.03, taste alteration; p