Abstract Background Tunnelled catheter-related bloodstream infections (CRBSIs) in haemodialysis are challenging to manage due to biofilm formation. Ethanol lock therapy (ELT) has demonstrated potential as an adjunct to antibiotics for catheter salvage, but robust evidence is limited. Methods We conducted a single-centre, open-label, randomised controlled trial of adult haemodialysis patients with suspected or confirmed CRBSI. Patients received either 70% ethanol lock therapy plus intravenous antibiotics or intravenous antibiotics alone. Primary outcome was catheter salvage at Day 7. Secondary outcomes included recurrence at Day 60, catheter survival, and adverse events. Results Eighty-four patients were randomised (42 per arm). Coagulase-negative Staphylococcus was the most common pathogen (34.5%). Early catheter salvage was higher with ethanol lock (78.6% vs 57.1%; P = 0.035). Recurrence was lower with ethanol lock at Day 60 (20.5% vs 53.7%; P = 0.002). Median catheter survival was longer (15 vs 8 days), though not statistically significant (P = 0.283). Fever resolution by Day 7 was significantly higher in the ethanol lock group compared to control (64.3% vs. 35.7%, P = 0.009). Adverse events were infrequent and mild. In multivariate analysis, higher serum albumin was independently associated with increased likelihood of catheter salvage (OR 2.43, P = 0.038), while longer dialysis vintage (OR 0.90, P = 0.035) and Pseudomonas infection (OR 0.05, P = 0.014) were associated with reduced salvage rates. Conclusion Adjunctive ethanol lock therapy improved early catheter salvage and reduced recurrence without significant adverse effects. These findings support its use as part of salvage protocols in tunnelled catheter infections.
K. et al. (2026) studied this question.