Table 1.
Characteristics of included studies
| NO. | Country | Sample size(T/C) | Gender(T/C, %) | Age(T/C) | Inclusion criteria | Exclusion criteria | Intervention | Control | Diagnosis of CRBSI | Catheter types | Follow up |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Bradley R.S. 2017 [12] | USA | 18/20 | 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 | 20/19 | 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 | 730/730 | 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 | 153/154 | 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 | 42/43 | 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 | 35/35 | 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 | 113/87 | 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 | 25/24 | 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 | 226/222 | 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 | 32/28 | 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. |