Phase 4
N=27
Preemptive Ethanol Lock Therapy in Pediatric Bloodstream Infection
Leukemia · Lymphoma · Blood Disorders · Solid Tumors
Bottom Line
View on ClinicalTrials.gov: NCT02095951 ↗Enrolled (actual)
27
Serious AEs
0.0%
Results posted
Dec 2018
Primary outcome: Primary: Length of Stay (LOS) in Those With 14 Confirmed Catheter Related Infection Cases — 124; 208 HOURS
Study Design & Population
- Study type
- Interventional
- Phase
- Phase 4
- Interventions
- Ethanol lock therapy (ELT) (Drug)
- Age
- Pediatric, Adult · 0+ yrs
- Sex
- All
- Sponsor
- Children's Hospital of Michigan
- Primary completion
- Jun 2016
Outcome Measures
| Outcome | Result | p-value |
|---|---|---|
| PRIMARY Length of Stay (LOS) in Those With 14 Confirmed Catheter Related Infection Cases |
124; 208 | — |
| PRIMARY Attributable Length of Stay (ALOS) in 14 Confirmed Catheter Related Infection Cases |
21; 32 | — |
| PRIMARY Hospital COSTS in 14 Confirmed Catheter Related Infection Cases |
11,441; 18,071 | — |
| SECONDARY Catheter Sterilization |
5; 9 | — |
| SECONDARY Catheter Salvage |
5; 9 | — |
| SECONDARY Number of Adverse Events Per Episode of Catheter Infection |
0; 0 | — |
| SECONDARY Re-infection |
0; 0 | — |
Summary
The study team will compare hospital length of stay (LOS) and attributable length of stay (ALOS, the LOS attributable to CRI), in a randomized, un-blinded prospective trial utilizing short-dwell ethanol-lock therapy (ELT) (4 hours to 24 hour dwell times per day, repeated for up to 72 hours) placed within 24 - 36 hours of admission(Group 1, Preemptive ELT) versus ELT placed at the time of first positive blood culture report (Group 2, Rescue ELT (Standard of Care ). ELT will be given in both groups, in combination with systemic antibiotics, for the treatment of CRI (suspected or proven) of the blood in children with central catheters. Participants will be enrolled from patients with hematologic/oncologic disorders and bone marrow or hematopoetic stem cell transplants (BMT) admitted for care to Children's Hospital of Michigan (CHM), a tertiary care pediatric hospital in Detroit, Michigan. ALOS will be defined as the number of hospital days between first symptoms of Catheter-related infection (CRI) (or date of admission for those admitted with symptoms) and first negative blood culture.
Study Hypothesis: The main hypothesis is that the short-dwell ethanol-lock therapy, defined above, placed within 24 - 36 hours of symptoms/admission (Arm 1) versus ELT placement at the time of first positive blood culture report (Arm 2), with concomitant systemic antibiotics, for the treatment of CRI (suspected or proven) of the blood in children with central catheters in the H/O/BMT population will have shorter hospital length of stay (LOS) and attributable LOS (ALOS) and therefore lower hospital costs.
Eligibility Criteria
Inclusion Criteria
- All children up to 21 years of age, with central catheters (any type) that develop symptoms and are admitted to CHM with an underlying H/O/BMT diagnosis for individual episodes of suspected or proven CRI of the blood, including rule out sepsis, will be screened for potential participation in this study.
- Individual CRI episodes in the same patient will be defined as a distinct central catheter associated blood stream infection if separated by greater than 28 days from prior ELT procedure and caused by a different organism identified on culture than the prior central catheter associated blood stream infection episode.
- Participants meeting study enrollment criteria will be offered participation and must have parental full informed consent, adolescent assent and young child verbal assent prior to enrollment as applicable.
Exclusion Criteria
- Children with documented allergy to ethanol or alcohol will be excluded. Blood cultures from patients that are reported positive for pathogen growth within 12 hours from the time they are obtained will be excluded from the study.
- Any patient at CHM with an infected central catheter and with another indwelling foreign body that communicates directly with the bloodstream, of which infection or colonization could not be excluded directly, will also be excluded from the study (i.e. Left Ventricular Assist Device) as it will not be possible to assess sterilization of the central catheter.
- Any patient with endocarditis or presumed endovascular infection will also be excluded.
- Any patient deemed critically ill or unstable, upon admission or during the early treatment course, in which case the treating clinician(s) feel that immediate line removal is potentially life-saving will be excluded from the study.
Data sourced from ClinicalTrials.gov (NCT02095951). Outcome figures and adverse-event rates are extracted automatically from the registry's posted results and are provided for clinician reference, not as a substitute for the primary publication.