Ethanol Lock Therapy for Treatment and Secondary Prophylaxis of Central Line-Associated Bloodstream Infection

NCT ID: NCT01472965

Last Updated: 2017-11-13

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: PHASE3
• Total Enrollment: 95 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2011-12-29
• Study Completion Date: 2016-11-11

Brief Summary

Use of long-term central venous access devices (including tunneled lines and ports) can be associated with development of bloodstream infection caused by build-up of bacteria or fungus on the inside of the device, called central line associated bloodstream infection (CLABSI). This infection generally requires hospital admission and antibiotic therapy. This treatment usually helps eradicate the infection but sometimes it is not possible to clear or it comes back after treatment. Also, once someone has had one line infection the chance of getting another one is higher. This study will test whether treatment and secondary prophylaxis of CLABSI with ethanol lock therapy (ELT) can significantly reduce the risk of treatment failure (comprising failure to clear initial infection, relapse or reinfection) in children and adolescents treated for cancer or hematologic disorders or undergoing hematopoietic stem cell transplantation (HSCT). ELT involves injecting a solution of ethanol and water into the line or port, allowing it to dwell for 2 hours, and then withdrawing the solution.

Detailed Description

Eligible patients with CLABSI will be enrolled within 96 hours of collection of positive blood culture and randomized to blinded treatment with 70% ethanol or heparin-saline placebo catheter lock therapy.

After enrollment, all subjects will receive catheter lock therapy for a 5 day Treatment Phase, followed by a 24 week Prophylaxis Phase. Participants in the active treatment arm will receive 70% ethanol locks and those in the placebo arm will receive heparin-saline placebo locks in identical fashion.

In addition to the study intervention, participants in both arms will receive standard systemic antibiotic therapy according to the preference of the ward clinician.

The intervention will continue for 24 weeks unless off-therapy criteria are met or the catheter is removed.

After the intervention is discontinued, participants will be monitored for 90 days, or 30 days after line removal, whichever is shorter. If the intervention is discontinued prior to 24 weeks due to adverse event or physician request, participants will be monitored for the remainder of the 24 week period.

Primary Objective:

• To compare the proportion of therapeutic failures in children and adolescents with CLABSI during treatment with standard care plus Ethanol Lock Therapy (ELT) versus standard care alone.

Secondary Objectives:

• To estimate and compare the cumulative incidence of CLABSI treatment failure, relapse or reinfection in children and adolescents receiving ELT plus standard care versus those receiving standard care alone.
• To estimate the risk of central venous access device (CVAD) occlusion associated with the use of ELT plus standard care, compared with standard care alone, in children and adolescents.
• To estimate the risk of adverse events possibly attributable to ELT associated with the use of ELT plus standard care, compared with standard care alone, in children and adolescents.

Conditions

Central Line-Associated Bloodstream Infection

Keywords

central line; adolescents; children; bloodstream infection; antibiotic lock therapy; catheter lock therapy; ethanol lock therapy

Study Design

• Allocation Method: RANDOMIZED
• Intervention Model: PARALLEL
• Primary Study Purpose: PREVENTION
• Blinding Strategy: QUADRUPLE

Study Groups

Treatment

Eligible patients with CLABSI will be enrolled within 96 hours of collection of positive blood culture and randomized to blinded treatment with 70% ethanol catheter lock therapy.

Group Type: ACTIVE_COMPARATOR

ethanol

Intervention Type: DRUG

70% ethanol catheter lock therapy

Control

Eligible patients with CLABSI will be enrolled within 96 hours of collection of positive blood culture and randomized to blinded treatment with heparin-saline placebo catheter lock therapy.

Group Type: PLACEBO_COMPARATOR

heparin-saline placebo

Intervention Type: DRUG

heparin-saline placebo catheter lock therapy

Interventions

ethanol

70% ethanol catheter lock therapy

Intervention Type: DRUG

heparin-saline placebo

heparin-saline placebo catheter lock therapy

Intervention Type: DRUG

Other Intervention Names

70% ethanol; heparin-saline

Eligibility Criteria

Inclusion Criteria

• Subjects ≥6 months to < 25 years of age who are ≥5kg
• New diagnosis (within 96 hours of collection of first positive blood culture) of CLABSI (participants with previous CLABSI will be eligible if not previously enrolled in the study)
• Silicone CVAD in situ (ports, Hickman and Broviac lines will all be eligible)
• Treating clinician plans to attempt salvage of CVAD
• Participant is receiving treatment for cancer or any hematologic disorder or is receiving hematopoietic stem cell transplantation (HSCT) at a participating institution.

Exclusion Criteria

• Allergy to ethanol or components of placebo lock
• Concomitant use of metronidazole, disulfiram or trabectedin
• Plan to remove CVAD within 6 days
• Continuous use of all lumens of CVAD leading to anticipated inability to lock each lumen for at least 2 hours per day
• Known CVAD obstruction
• Subjects who are capable of becoming pregnant will require an negative pregnancy test before entry to study
• Use of ELT in the preceding 2 weeks
• Expected survival <6 days
• Proven alternative source of bloodstream infection (BSI), or clinical evidence of CVAD track or port-pocket infection
• Multiple long-term CVADs in situ

• Minimum Eligible Age: 6 Months
• Maximum Eligible Age: 25 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

St. Jude Children's Research Hospital

OTHER

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Principal Investigators

Joshua Wolf, MBBS, BA

Role: PRINCIPAL_INVESTIGATOR

St. Jude Children's Research Hospital

Locations

St. Jude Children's Research Hospital

Memphis, Tennessee, United States

Royal Children's Hospital Melbourne

Parkville, Victoria, Australia

Countries

United States; Australia

References

Wolf J, Connell TG, Allison KJ, Tang L, Richardson J, Branum K, Borello E, Rubnitz JE, Gaur AH, Hakim H, Su Y, Federico SM, Mechinaud F, Hayden RT, Monagle P, Worth LJ, Curtis N, Flynn PM. Treatment and secondary prophylaxis with ethanol lock therapy for central line-associated bloodstream infection in paediatric cancer: a randomised, double-blind, controlled trial. Lancet Infect Dis. 2018 Aug;18(8):854-863. doi: 10.1016/S1473-3099(18)30224-X. Epub 2018 Jun 5.

Reference Type: DERIVED

PMID: 29884572 (View on PubMed)

Related Links

http://www.stjude.org

St. Jude Children's Research Hospital

http://www.stjude.org/protocols

Clinical Trials Open at St. Jude

Other Identifiers

ETHEL

Identifier Type: -

Identifier Source: org_study_id