1887

Abstract

The aim of this study was to compare the activity of ethanol, EDTA and levofloxacin (Levo), alone or in combination, on biofilms of recovered from patients with catheter-related bloodstream infections (CRBSIs) at a university hospital in Argentina. First, 24 and 48 h biofilms were formed in microtitre plates and challenged with 25 or 40 % ethanol for 1 h. Biofilms, of the 14 local isolates and from the reference strain K279a, were eradicated after both treatments as shown by plate counts and the regrowth technique. Second, 24 h biofilms of all isolates were established in silicone catheter segments and challenged with 25 or 40 % ethanol, Levo (2.5 mg ml), EDTA (30 mg ml), 25 % ethanol–EDTA or Levo–EDTA for 1, 3 and 24 h. Viable counts of biofilms treated for 1 h with 25 or 40 % ethanol or 25 % ethanol–EDTA were under the limit of detection. Killing of biofilms by Levo or Levo–EDTA was gradual and it was only after 24 h of treatment that no differences could be seen between the effects of these catheter lock solutions (CLSs) and those of ethanol (>0.05). Levo–EDTA, in combination, did not act synergistically against biofilms. After 24 h of exposure, EDTA did not eradicate biofilms but reduced biofilm survival rates to 1–5 %. The effect of the different CLSs on biomass reduction, estimated by crystal violet staining, was highly dependent on the isolate, and the most effective agents were 25 and 40 % ethanol. Our results suggest that when used as a CLS for short periods, ethanol at low concentrations, alone or in combination with a chelator, can decontaminate the line from in cases of CRBSI and help, in conjunction with systemic antibiotics, in the retention of precious vascular catheters.

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2012-09-01
2019-10-17
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References

  1. Balestrino D., Souweine B., Charbonnel N., Lautrette A., Aumeran C., Traoré O., Forestier C.. ( 2009;). Eradication of microorganisms embedded in biofilm by an ethanol-based catheter lock solution. . Nephrol Dial Transplant 24:, 3204–3209. [CrossRef][PubMed]
    [Google Scholar]
  2. Bleyer A. J., Mason L., Russell G., Raad I. I., Sherertz R. J.. ( 2005;). A randomized, controlled trial of a new vascular catheter flush solution (minocycline–EDTA) in temporary hemodialysis access. . Infect Control Hosp Epidemiol 26:, 520–524. [CrossRef][PubMed]
    [Google Scholar]
  3. Bookstaver P. B., Gerrald K. R., Moran R. R.. ( 2010;). Clinical outcomes of antimicrobial lock solutions used in a treatment modality: a retrospective case series analysis. . Clin Pharmacol 2:, 123–130.[PubMed]
    [Google Scholar]
  4. Broom J., Woods M., Allworth A., McCarthy J., Faoagali J., Macdonald S., Pithie A.. ( 2008;). Ethanol lock therapy to treat tunnelled central venous catheter-associated blood stream infections: results from a prospective trial. . Scand J Infect Dis 40:, 399–406. [CrossRef][PubMed]
    [Google Scholar]
  5. Broom J. K., O’Shea S., Govindarajulu S., Playford E. G., Hawley C. M., Isbel N. M., Campbell S. B., Mudge D. W., Carpenter S.. & other authors ( 2009;). Rationale and design of the HEALTHY-CATH trial: a randomised controlled trial of Heparin versus EthAnol Lock THerapY for the prevention of Catheter Associated infecTion in Haemodialysis patients. . BMC Nephrol 10:, 23. [CrossRef][PubMed]
    [Google Scholar]
  6. Chambers S. T., Peddie B., Pithie A.. ( 2006;). Ethanol disinfection of plastic-adherent micro-organisms. . J Hosp Infect 63:, 193–196. [CrossRef][PubMed]
    [Google Scholar]
  7. Cober M. P., Kovacevich D. S., Teitelbaum D. H.. ( 2011;). Ethanol-lock therapy for the prevention of central venous access device infections in pediatric patients with intestinal failure. . JPEN J Parenter Enteral Nutr 35:, 67–73. [CrossRef][PubMed]
    [Google Scholar]
  8. Crossman L. C., Gould V. C., Dow J. M., Vernikos G. S., Okazaki A., Sebaihia M., Saunders D., Arrowsmith C., Carver T.. & other authors ( 2008;). The complete genome, comparative and functional analysis of Stenotrophomonas maltophilia reveals an organism heavily shielded by drug resistance determinants. . Genome Biol 9:, R74. [CrossRef][PubMed]
    [Google Scholar]
  9. Dannenberg C., Bierbach U., Rothe A., Beer J., Körholz D.. ( 2003;). Ethanol-lock technique in the treatment of bloodstream infections in pediatric oncology patients with broviac catheter. . J Pediatr Hematol Oncol 25:, 616–621. [CrossRef][PubMed]
    [Google Scholar]
  10. Denton M., Kerr K. G.. ( 1998;). Microbiological and clinical aspects of infection associated with Stenotrophomonas maltophilia. . Clin Microbiol Rev 11:, 57–80.[PubMed]
    [Google Scholar]
  11. Donlan R. M.. ( 2011;). Biofilm elimination on intravascular catheters: important considerations for the infectious disease practitioner. . Clin Infect Dis 52:, 1038–1045. [CrossRef][PubMed]
    [Google Scholar]
  12. Fernandez-Hidalgo N., Almirante B., Calleja R., Ruiz I., Planes A. M., Rodriguez D., Pigrau C., Pahissa A.. ( 2006;). Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study. . J Antimicrob Chemother 57:, 1172–1180. [CrossRef][PubMed]
    [Google Scholar]
  13. Maiefski M., Rupp M. E., Hermsen E. D.. ( 2009;). Ethanol lock technique: review of the literature. . Infect Control Hosp Epidemiol 30:, 1096–1108. [CrossRef][PubMed]
    [Google Scholar]
  14. Mermel L. A., Allon M., Bouza E., Craven D. E., Flynn P., O’Grady N. P., Raad I. I., Rijnders B. J., Sherertz R. J., Warren D. K.. ( 2009;). Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. . Clin Infect Dis 49:, 1–45. [CrossRef][PubMed]
    [Google Scholar]
  15. Mouw E., Chessman K., Lesher A., Tagge E.. ( 2008;). Use of an ethanol lock to prevent catheter-related infections in children with short bowel syndrome. . J Pediatr Surg 43:, 1025–1029. [CrossRef][PubMed]
    [Google Scholar]
  16. Onland W., Shin C. E., Fustar S., Rushing T., Wong W. Y.. ( 2006;). Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in pediatric patients. . Arch Pediatr Adolesc Med 160:, 1049–1053. [CrossRef][PubMed]
    [Google Scholar]
  17. Passerini de Rossi B., Calenda M., Vay C., Franco M.. ( 2007;). Biofilm formation by Stenotrophomonas maltophilia isolates from device-associated nosocomial infections. . Rev Argent Microbiol 39:, 204–212.[PubMed]
    [Google Scholar]
  18. Passerini de Rossi B., García C., Calenda M., Vay C., Franco M.. ( 2009;). Activity of levofloxacin and ciprofloxacin on biofilms and planktonic cells of Stenotrophomonas maltophilia isolates from patients with device-associated infections. . Int J Antimicrob Agents 34:, 260–264. [CrossRef][PubMed]
    [Google Scholar]
  19. Poole C. V., Carlton D., Bimbo L., Allon M.. ( 2004;). Treatment of catheter-related bacteraemia with an antibiotic lock protocol: effect of bacterial pathogen. . Nephrol Dial Transplant 19:, 1237–1244. [CrossRef][PubMed]
    [Google Scholar]
  20. Qu Y., Istivan T. S., Daley A. J., Rouch D. A., Deighton M. A.. ( 2009;). Comparison of various antimicrobial agents as catheter lock solutions: preference for ethanol in eradication of coagulase-negative staphylococcal biofilms. . J Med Microbiol 58:, 442–450. [CrossRef][PubMed]
    [Google Scholar]
  21. Raad I., Hanna H., Dvorak T., Chaiban G., Hachem R.. ( 2007;). Optimal antimicrobial catheter lock solution, using different combinations of minocycline, EDTA, and 25-percent ethanol, rapidly eradicates organisms embedded in biofilm. . Antimicrob Agents Chemother 51:, 78–83. [CrossRef][PubMed]
    [Google Scholar]
  22. Sanders J., Pithie A., Ganly P., Surgenor L., Wilson R., Merriman E., Loudon G., Judkins R., Chambers S.. ( 2008;). A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. . J Antimicrob Chemother 62:, 809–815. [CrossRef][PubMed]
    [Google Scholar]
  23. Sherertz R. J., Boger M. S., Collins C. A., Mason L., Raad I. I.. ( 2006;). Comparative in vitro efficacies of various catheter lock solutions. . Antimicrob Agents Chemother 50:, 1865–1868. [CrossRef][PubMed]
    [Google Scholar]
  24. Takla T. A., Zelenitsky S. A., Vercaigne L. M.. ( 2008;). Effectiveness of a 30 % ethanol/4 % trisodium citrate locking solution in preventing biofilm formation by organisms causing haemodialysis catheter-related infections. . J Antimicrob Chemother 62:, 1024–1026. [CrossRef][PubMed]
    [Google Scholar]
  25. Vanholder R., Canaud B., Fluck R., Jadoul M., Labriola L., Marti-Monros A., Tordoir J., Van Biesen W.. ( 2010;). Diagnosis, prevention and treatment of haemodialysis catheter-related bloodstream infections (CRBSI): a position statement of European Renal Best Practice (ERBP). . NDT Plus 3:, 234–246. [CrossRef]
    [Google Scholar]
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