Comparative effectiveness of catheter salvage strategies for pediatric catheter-related bloodstream infections

Abstract Background Intravascular catheter salvage may be attempted in clinically suitable cases in pediatric patients with catheter-related bloodstream infections. The purpose of this study was to assess the effectiveness of ethanol and hydrochloric acid (HCl) locks in achieving catheter salvage th...

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Bibliographic Details
Published in:Journal of pediatric surgery 2016-02, Vol.51 (2), p.296-301
Main Authors: Hu, Yinin, Guidry, Christopher A, Kane, Bartholomew J, McGahren, Eugene D, Rodgers, Bradley M, Sawyer, Robert G, Rasmussen, Sara K
Format: Article
Language:English
Subjects:
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents, Local - administration & dosage
Anti-Infective Agents, Local - economics
Bacteremia - drug therapy
Catheter-related bloodstream infection
Catheter-Related Infections - drug therapy
Catheter-Related Infections - prevention & control
Catheters, Indwelling - microbiology
Child
Combined Modality Therapy
Cost-Benefit Analysis
Cost-effectiveness
Decision analysis
Ethanol - administration & dosage
Ethanol - economics
Ethanol lock
Humans
Hydrochloric Acid - administration & dosage
Hydrochloric Acid - economics
Hydrochloric acid lock
Markov Chains
Pediatrics
Surgery
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Summary:Abstract Background Intravascular catheter salvage may be attempted in clinically suitable cases in pediatric patients with catheter-related bloodstream infections. The purpose of this study was to assess the effectiveness of ethanol and hydrochloric acid (HCl) locks in achieving catheter salvage through decision-analysis modeling. Methods A Markov decision model was created to simulate catheter salvage using three management strategies: systemic antibiotics alone, antibiotics plus HCl lock, and antibiotics plus ethanol lock. One-way and two-way sensitivity analyses were performed for all model variables. Infection control rates and recurrence rates for each strategy were derived from prospective institutional data and existing pediatric literature. Costs were derived from institutional charges. Results With antibiotics alone, 73% of patients would require line replacement within 100 days, compared to only 31% and 19% of patients treated with HCl and ethanol lock, respectively. Incremental cost per additional catheter salvaged is $89 for HCl lock and $456 for ethanol lock. Superior efficacy of adjunct lock therapy is insensitive to changes in the anticipated duration of central access requirement and to clinically relevant variations in all model input variables. Conclusion HCl or ethanol locks are cost-effective adjuncts to systemic antibiotics for attempted catheter salvage in the setting of catheter-related bloodstream infections.
ISSN:0022-3468
1531-5037
DOI:10.1016/j.jpedsurg.2015.10.079