Role of hydrochloric acid in the treatment of central venous catheter infections in children with cancer

BACKGROUND. The use of central venous catheters (CVCs) in pediatric cancer patients is associated with substantial risk of producing sepsis. The treatment of catheter-related infections has generally consisted of antibiotic administration with or without catheter removal. The authors report the first published experience using intraluminal hydrochloric acid (HCI) instillation as an adjunct to systemic antimicrobials in the management of catheter-related infections in children with cancer. METHODS. All episodes of intraluminal instillation of 2 M HCI in oncology patients at The Children's Hospital at Westmead between December 1994 and August 2000 were reviewed. Episodes of HCl use were identified from a prospectively maintained infection data base. Successful treatment was defined as no recurrence of infection and no need for CVC removal in the 100 days after HCl administration. RESULTS. Forty-two episodes of HCl instillation were evaluated that occurred in children in whom blood cultures remained positive despite 48 hours of appropriate, systemic antibiotics and formed the basis of this review. All patients had in situ a surgically placed, subcutaneously tunneled CVC. The combination of systemic antibiotic therapy and HCl instillation was successful in eradicating infection in 67% of infection episodes in this patient cohort. The catheter salvage rate was 83% in patients with isolated Gram-negative infections, 75% in patients with isolated fungemia, and 50% in patients with isolated Gram-positive infections. CONCLUSIONS. The results suggest that HCl instillation is a useful adjunct to systemic antibiotic therapy, enabling both catheter salvage and eradication of antibiotic-refractory catheter-related infection.