Table 1 Characteristics of included studies

Bradley R.S. 2017 [12]

USA

M(33/30)

49/52

Adult patients providing consent, non-medicare insurance, or medicare insurance with a supplementary insurance, anticipated duration on home parenteral nutrition(HPN) > 3 m not previously on HPN at Mayo Clinic or elsewhere, patients with single lumen, silicone Hickman ® catheters, and no known alcohol addiction

Failure to provide consent, medicare insurance without supplemental private insurance, patients with a catheter type other than a single lumen Hickman ®, patients who were anticipated to be on HPN for less than three months, pregnant patients, patients who have previously proven addiction and/or dependence to alcohol

3 ml 70% ethanol lock until next PN infusion

Heparin lock plus saline infusion

(1)Bacteremia or fungemia in a patient who had an intravascular device and > 1 positive blood culture result obtained from the peripheral vein; (2)Clinical manifestations of infection (e.g., fever, chills, and/or hypotension), and no apparent source for blood stream infection other than the central venous catheter.

Single lumen, silicone Hickman ® catheters

NA

Lavern M.V. 2016 [7]

Canada

M(60/47)

63/62.3

Eligible participants were 18 years of age or older with end-stage renal disease and planned vascular access with a catheter or current hemodialysis patients requiring exchange of an existing catheter

(1) they were critically ill in the ICU setting, (2) had acute kidney injury and were unlikely to require prolonged vascular access, (3) had a maturing or planned arteriovenous fistula/graft creation within 2 months, or (4) planned antibiotic treatment courses lasting longer than 4 weeks from the date of the new catheter insertion.

2.5 ml 30% ethanol/4% sodium citrate for a 6-month period

Heparin 1000 units/mL

Two or more positive blood cultures of the same organism (species, antibiogram) from any source (peripheral or intravascular device cultures) from a patient with clinical and microbiologic data suggesting no other source for the bacteremia except the intravascular device.

Inserted dual-lumen tunneled, cuffed catheters made of carbothane, an alcohol-resistant polymer with silicone extensions (Tal Palindrome, Tyco Healthcare Kendall/Covidien, Mansfield, MA, USA)

If an outcome occurred, an additional 30 days for safety was added

Bertrand 2015 [6]

France

M(60.8/61.1)

65/66

Patients required insertion of DCs with an expected duration of use longer than 48 h in ICU

Ethanol intolerance and pregnancy

60% wt/wt EL locks for 2 min

0.9% saline lock

In patients with one or more blood cultures positive for coagulase-negative staphylococci, identity of pulse-field gel electrophoresis patterns in the catheter tip and blood cultures was required for a diagnosis of CRBSI

A nontunneled, nonantimicrobial-impregnated double-lumen dialysis catheters (DC)

Until death or 48 h after ICU discharge

Reineke A 2015 [8]

Netherlands

M(58/56)

9.8/7.8

Paediatric oncology patients (1–18 years) with a newly inserted, tunnelled central venous catheters (CVC)

≤1 year at diagnosis, a primary immunological disorder, an ethanol allergy or a CVC inserted in a vessel with previously confirmed thrombosis

70% ethanol locks for 2 h

100 IU/ml heparin locks

At least one of the following criteria: (1) recognised pathogen cultured from ≥1 blood cultures, not related to an infection at another site

(2) Clinical manifestations of infection and a common skin microorganism (such as coagulase-negative staphylococci (CoNS), diphtheroids, Bacillus spp., or micrococci) cultured from ≥2 blood cultures drawn on separate occasions

Tunnelled CVC(port-a-cath (PAC) or Broviac)

Time to CABSI or death due to CABSI, during a maximum follow-up period of six months

L.J. Worth 2014 [16]

Australia

M(28/24)

47.0/48.1

Patients with haematological malignancy or planned BMT were eligible for enrolment at time of insertion of a dual lumen, non-antibiotic-impregnated, tunnelled, cuffed, intravascular catheter (Hickman catheter) into subclavian or internal jugular veins, where the intended period of catheterization was 30 days.

NA

70% ethanol locks for 2 h

Heparinized saline

A positive blood culture with a recognized pathogen or common commensal, with confirmation of infection by isolation of the same organism following culture of catheter tip, or a differential time to positivity for centrally and peripherally drawn blood cultures of 2 h

A dual lumen, non-antibiotic-impregnated, tunnelled, cuffed, intravascular catheter (Hickman catheter)

Until a device-related bloodstream infection occurred, or planned study end-date

Sishir 2014 [15]

India

NA

NA

Hemodialysis population

NA

70% ethanol lock for 20 min

Heparin lock (1000 U/ml)

NA

Double lumen polyurethane hemodialysis cathete

NA

Mara 2014 [14]

Spain

M(55/54)

67.3/65.2

Recent MHS admission with Central Vascular Catheters (CVC) inserted >48 h; Age >18 years; No evidence or suspicion of CRBSI at enrolment: No signs of infection neither general nor at catheter site entrance

Allergy or intolerance to ethanol or chronic liver disease;Pregnancy

70% ethanollock for 2 h

Conventional catheter-care

Microbiologically proven CRBSI considered when the same microorganism was recovered from blood and a catheter tip within less than 8 days.

Conventionalcatheter

Enrolled patients were prospectively followed for the occurrence of CR-BSI until catheter withdrawal, hospital discharge or death

Jennifer K 2012 [13]

Australia

M(52/46)

52/64

Adults > 18 years, the presence of a tunnelled intravenous catheter and the ability to give informed consent

Pregnancy or breast feeding, religious or personal objection to the use of ethanol, intolerance of ethanol, and a history of an exit site, tunnel or blood stream infection associated with the current catheter.

70% ethanol for 48 h

Thrice weekly standard heparin locks(Heparin sodium 5000 U/Ml)

(1)Positive blood cultures for the presence of bacteria with or without Clinical manifestations of infection

A tunnelled central venous catheter

NA

Lennert Solbbe 2010 [11]

Netherlands

M(57.5/56.3)

51.7/49.8

Eligible study-participants were all consecutive adult (age>17 years) hematology patients with a tunnelled silicone CVC, inserted in the preceding 72 h before study-entry

Patients with an alcohol-intolerance or concomitant treatment with metronidazole

70% ethanol lock for 15 min per day

0.9% NaCl

A positive central or peripheral blood culture; For (coagulase-negative staphylococci) or other skin-colonizers, 2 blood cultures had to be positive when no peripheral cultures were available [19]

A tunnelled silicone CVC

NA

Sanders 2008 [10]

New Zealand

M(53/57)

52.4/47.2

An age >18 years or older and admission as an inpatient to receive intensive chemotherapy likely to produce neutropenia (<0.5 × 109 L) for the treatment of haematological disease, including haematopoietic stem cell transplantation.

Abnormal liver function tests or a history of alcohol abuse

70% ethanol for 2 h

Control

The culture of a recognized pathogen from one or more blood cultures, unrelated to infection at another site [18].

Identical dual lumen Hickman central venous catheters

The study period ended with either diagnosis of CABSI, removal or failure of catheter, discharge from hospital, death or end of study period after an arbitrary 30 days.