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

Abstract

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.

Central venous catheter safety in pediatric patients with intestinal failure

“…Antimicrobial locks (Figure 2) are effective at preventing infection, but depending on the lock type, may affect catheter integrity and have varying degrees of effectiveness against various organisms 26,27 . Despite their frequent use, there is a paucity of quality data and commercially available options for lock therapy for patients with IF in the United States 28–30 . The ideal antimicrobial lock would be inexpensive, readily available, safe to flush into systemic circulation, exert dual antimicrobial and anticoagulant properties without risk of bacterial resistance or compromising catheter integrity, require minimal dwell time to function, and have the same density as blood to minimize extravasation from the catheter.…”

Keeping the Culture of CLABSI Elimination Alive

“…As an efficacious, well‐studied, widely used agent, ETL has shown to significantly lower CLABSI rates in children with IF from 8 to 10 infections per 1000 catheter days ~10 years ago to <2 infections per 1000 catheter days now (4,5). The revolution of CLABSI prevention with AML, particularly ethanol locks, is indisputable and supported by a myriad of studies described in the article by Gibson et al (6). While Gibson et al note variation in study quality and lack of randomized‐controlled trials, the evidence in favor of AML therapy with attention to patient outcomes, safety, efficacy, and health care costs seems all but irrefutable.…”