Randomized Trial Comparing Minocycline-EDTA-Ethanol Lock to Standard-of-Care Antibiotic Lock for Management of Central Line-Associated Bloodstream Infection
In brief
Minocycline-EDTA-ethanol lock retained 57% of infected catheters
In this randomized trial, 57% of patients receiving minocycline-EDTA-ethanol lock therapy kept their infected long-term catheter, compared with 38% receiving standard antibiotic lock therapy. Clinical and microbiological failures were also less common, while serious adverse events and mortality were similar; the findings support catheter salvage, though the trial included patients aged 12 and older across varied settings.
- Journal
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America (Q1)
- Published
- 16 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Anne-Marie Chaftari, Vinay Rathore, Ray Hachem, Toan T Huynh, Paul P Cook, Onix Cantres-Fonseca, et al.
- PMID
- 42886055
- DOI
- 10.1093/cid/ciag660
Why clinicians should know about it
- Picked for Microbiology (medical) (paper of the day, 17 October 2026): MLT superior to SOC‑ALT in salvaging long‑term CVCs in CLABSI
Abstract
BACKGROUND: Central line-associated bloodstream infections (CLABSI) cause substantial morbidity and mortality. Management often requires removing the infected central venous catheter (CVC) and inserting a new one. Effective catheter-salvage strategies are needed. METHODS: An international, multicenter, prospective, randomized superiority trial at 34 centers in the United States, Puerto Rico, and India enrolled patients aged ≥12 years with a long-term central venous catheter (CVC) in place for ≥5 days and CLABSI. Participants were randomized 1:1 to receive systemic antibiotics plus minocycline-EDTA-ethanol lock therapy (MLT) or standard-of-care antibiotic lock therapy (SOC-ALT) for 7 to 14 days. The primary endpoint was median time to catheter failure, defined as clinical failure (death, infection-related catheter removal, worsening symptoms) or microbial failure (persistent/recurrent infection or new deep-seated infection attributable to the index CLABSI). RESULTS: From 2018-2024, 241 patients were randomized; 228 received lock therapy. Catheter retention was higher with MLT than SOC-ALT (57% vs 38%; P = 0.0025). Median time to catheter failure was longer with MLT in both intention-to-treat (not estimable vs 33 days, HR 0.53, P = 0.0006) and modified intention-to-treat populations (not estimable vs 35 days, HR 0.50, P = 0.0005). Clinical catheter failure (13% vs 28%; P = 0.006) and microbiological failure (5% vs 15%; P = 0.012) were lower with MLT. Adverse events, serious adverse events, and mortality were similar between groups, with no drug-related serious adverse events. CONCLUSIONS: MLT was superior to SOC-ALT in salvaging long-term CVCs in CLABSI and was well tolerated, addressing an unmet need in CLABSI management.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.