Comparative efficacy of various antimicrobial lock solutions for preventing catheter-related bloodstream infections: A network meta-analysis of 9099 patients from 52 randomized controlled trials

Abstract

Objectives: It remains uncertain which catheter lock solution (CLS) to prevent catheter-related bloodstream infections (CRBSI) works best and is safest for patients. This study was performed to compare the efficacy of different CLSs for the prevention of CRBSI and ranked these CLSs for practical consideration. Methods: The PubMed, Web of Science, Embase, and MEDLINE databases, earlier relevant meta-analyses, and the reference lists of included studies were searched. The primary outcome was CRBSI; secondary outcomes were catheter-related thrombosis and exit-site infections. A network meta-analysis was performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 52 randomized controlled trials involving 9099 patients and evaluating 13 CLSs (single and combinations) were included. With regard to the quality of the evidence, the risk of bias was typically low or unclear (45 out of 52 trials, 86.5%). In the network meta-analysis, saline (OR 8.44, 95% CI 2.19-32.46), gentamicin + citrate (OR 2.92, 95% CI 1.32-6.42), ethanol (OR 5.33, 95% CI 1.22-23.32), and cloxacillin + heparin (OR 2.07, 95% CI 1.19-5.49) were associated with a greater effect on CRBSI than heparin. Conclusions: This network meta-analysis showed that minocycline-ethylenediaminetetraacetic acid (EDTA) seemed to be the most effective for the prevention of CRBSI and exit-site infection, and cefotaxime + heparin seemed to be the most effective for catheter-related thrombosis.

Minimising Blood Stream Infection: Developing New Materials for Intravascular Catheters

“…This has the primary purpose of removing blood from the line such that occlusion and bacterial growth are minimised (discussed in Section 2) [26,27,30,67]. While the use of a saline flush is standard, other components can also be introduced and perform a variety of roles: anti-occlusion (heparin), antibiotic (vancomycin, gentamicin) and antimicrobial (citrate, ethanol and taurolidine) [68][69][70]. Vancomycin and gentamicin are generally reserved for therapeutic measures once a CRBSI has been diagnosed [22,46,[71][72][73].…”

“…There is no standard recommendation as to the use of catheter locks and their over-arching function is to maintain the integrity of the line. An extensive literature based on their application and investigations of their efficacy has emerged in recent years but a detailed discussion of their individual use is beyond the scope of the present study and the reader is directed to more comprehensive reviews [68][69][70].…”

“…The effectiveness of such an approach is however relatively short term as prolonged contact with blood eventually leads to the removal of the albumin. The use of heparin as a catheter lock is well established where it is employed to prevent thrombus and occlusion of the line [67][68][69][70]84]; catheter surfaces coated with the molecule have also exhibited marked resistance to non-specific protein fouling [92,119,140]. Several conflicting mechanisms for this action have been suggested (electrostatic repulsion, protein specific interactions, inhibition of bacterial adhesions etc.)…”

Efficacy of Antimicrobial Lock Solutionsagainst Catheter-Related Infections in Hemodialysis Patients

“…The appropriate maintenance of central venous catheters (CVC) is integral for the efficacy and safety of hemodialysiswhich requires systematic catheterization for bloodstream access (Dang et al, 2019). Catheter thrombosis or catheter-related bloodstream infections (CRBSI) are common complications for patients undergoing hemodialysis (Sofroniadou et al, 2017).…”

Antimicrobial Lock Therapy in Clinical Practice: A Scoping Review Protocol

“…These studies are different from each other according to their methodology and setting ranging from the network meta-analysis by Dang et al published in 2019, to experimental models such as that proposed by Basas J. and colleagues. According to Dang et al minocycline-ethylenediaminetetraacetic acid (EDTA) is effective in the prevention of CRBSI and exit-site infection [21], while the study by Basas J. et al on rabbit model showed that liposomal amphotericin B (LAmB) ALT or anidulafungin ALT can be used to treat CLABSIs infections by Candida glabrata and Candida albicans [22]. Because of the wide range of available evidence on CLABSIs management, this scoping review unlike the previous systematic reviews [23] does not aim to give recommendations on the use of ALT but aims to furnish a map and a synthesis on this topic, offering a base for the development of new clinical practice indications and health policies.…”