P4.01: Reduction of central line associated bloodstream infections and line occlusions in pediatric intestinal failure patients on long-term parenteral nutrition using an alternate locking solution, Kitelock

Quirt, Jill; Belza, Christina; Pai, Nikhil; Markovic, Filip; Wong-Sterling, Sylvia; Avitzur, Yaron; Wales, Paul W.

doi:10.1097/01.tp.0000576268.46134.62

Cited by 1 publication

(7 citation statements)

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“…This study confirms that AML therapy likely reduces the rates of CRBSI in pediatric patients with IF. Randomized control trials that directly compare AML solutions (including newer solutions such as EDTA (43)) are required, recognizing that it may be difficult to attain a large enough sample size to demonstrate superiority. Such studies should include careful analysis of the incidence of thrombosis and other adverse events that are potentially attributable to AML solutions.…”

Section: Discussionmentioning

confidence: 99%

“…Another study reported discontinuation of ethanol AML in 2 patients due to thrombosis (19). In contrast to these studies, 1 reported a trend towards less thrombosis in the ethanol group (24), and there was a statistically significant reduction in line occlusions in the study using the tetrasodium-EDTA AML solution (43). Three studies using taurolidine-citrate AML reported on CVC occlusions.…”

Section: Secondary Outcomesmentioning

confidence: 95%

“…The incidence of and/or indications for CVC replacement were reported in 13 studies. Three reported no statistically significant difference in the incidence of unplanned CVC removal (22,29,39), 8 reported a lower incidence in the AML group (17)(18)(19)(20)23,30,42,43), and 1 with ethanol reported a higher incidence in the AML group (27). One study reported a statistically significant decrease in CVC replacements for infection, but a statistically significant increase in replacements for line occlusion or breakage in the ethanol group (26).…”

Section: Secondary Outcomesmentioning

confidence: 98%

“…The need for line removal following occlusion was not clearly reported in the studies. Reports of other adverse effects related to AML solutions were limited to 3 individual cases: facial flushing and irritability with 70% ethanol (20), gastrointestinal upset with taurolidinecitrate (39), and discomfort with withdrawal of the 4% tetrasodium-EDTA solution from the CVC (43).…”

Section: Secondary Outcomesmentioning

confidence: 99%

“…The remaining 4 studies used the following AML solutions: (1) tobramycin-tPA, (2) recombinant tissue plasminogen activator (rtPA), (3) tetrasodium-EDTA, and (4) gentamicin, vancomycin, or amikacin. Three included patients up to 20 years old (24,31,43), and the fourth enrolled patients up to 12 years but continued follow up until 25 years of age (37).…”

Section: Study Characteristicsmentioning

confidence: 99%

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Systematic Review of Antimicrobial Lock Solutions for Prevention of Bacteremia in Pediatric Patients With Intestinal Failure

McNiven

Sebastianski

et al. 2022

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: The goal of this systematic review was to determine whether antimicrobial lock (AML) solutions prevent catheter-related bloodstream infections (CRBSI) in children with intestinal failure (IF). Methods: Electronic databases were searched: Ovid MEDLINE (1946–), Ovid Embase (1974–), Wiley Cochrane Library (inception–), and Web of Science Core Collection via Clarivate Analytics (1900–). Randomized and nonrandomized trials, case or cohort studies that studied any AML solution, and used comparator groups were included if they studied children with IF. A meta-analysis compared the rates of CRBSI with AML solutions versus controls, and a Boucher analysis was used to indirectly compare AML solutions. Results: Twenty-eight studies met eligibility criteria (1 open label and 27 observational studies). Quality was good (N = 13), fair (N = 9), and poor (N = 6). All but 4 studied ethanol and taurolidine. Of 15 ethanol studies, 11 reported a decrease and 3 reported a trend toward a decreased incidence of CRBSI compared to controls; 1 reported no difference. Of 9 taurolidine studies, 7 reported a decrease and 2 a trend toward decreased CRBSI rates. There was a decrease in CRBSI with ethanol versus control (P = 0.008) and with taurolidine-citrate versus control (P < 0.0005). Using Bucher indirect comparison of the pooled estimates from ethanol versus control to taurolidine versus control, the estimated difference was −0.99 (−4.125, 2.27; P = 0.55). Conclusions: There were no randomized trials and over half of the 28 included studies were fair or poor quality. All but 1 reported at least a trend toward reduction in CRBSI. AML solutions appear to prevent CRBSI.

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Section: Discussionmentioning

confidence: 99%