TY - JOUR
T1 - Antimicrobial lock solutions as a method to prevent central line-associated bloodstream infections
T2 - A meta-analysis of randomized controlled trials
AU - Zacharioudakis, Ioannis M.
AU - Zervou, Fainareti N.
AU - Arvanitis, Marios
AU - Ziakas, Panayiotis D.
AU - Mermel, Leonard A.
AU - Mylonakis, Eleftherios
N1 - Publisher Copyright:
© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved.
PY - 2014/12/15
Y1 - 2014/12/15
N2 - Background. Antimicrobial lock solutions may be an effective strategy to prevent catheter-associated infections. However, there remains concern about their efficacy and safety. Methods. To investigate the efficacy of antimicrobial lock therapy to prevent central line-associated bloodstream infections (CLABSIs), we performed a systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, from the earliest date up to 31 December 2013. Studies were eligible if they were randomized controlled trials comparing antimicrobial lock solutions to heparin and if they provided an appropriate definition of infection. Results. The 23 included studies reported data on 2896 patients, who were predominantly adult patients undergoing hemodialysis (16/23 studies), but also adult and pediatric oncology patients, critically ill neonates, and patients receiving total parenteral nutrition. The use of antimicrobial lock solutions led to a 69% reduction in CLABSI rate (relative risk [RR], 0.31; 95% confidence interval [CI],.24-.40) and a 32% reduction in the rate of exit site infections (RR, 0.68; 95% CI,.49-.95) compared with heparin, without significantly affecting catheter failure due to noninfectious complications (RR, 0.83; 95% CI,.65-1.06). All-cause mortality was not different between the groups (RR, 0.84; 95% CI.64-1.12). Neither the type of antimicrobial solution nor the population studied, affected the relative reduction in CLABSIs, which also remained significant among studies reporting baseline infection rates of <1.15 per 1000 catheter-days, and studies providing data for catheter-related bloodstream infections. Publication and selective reporting bias are a concern in our study and should be acknowledged. Conclusions. Antimicrobial lock solutions are effective in reducing risk of CLABSI, and this effect appears to be additive to traditional prevention measures.
AB - Background. Antimicrobial lock solutions may be an effective strategy to prevent catheter-associated infections. However, there remains concern about their efficacy and safety. Methods. To investigate the efficacy of antimicrobial lock therapy to prevent central line-associated bloodstream infections (CLABSIs), we performed a systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, from the earliest date up to 31 December 2013. Studies were eligible if they were randomized controlled trials comparing antimicrobial lock solutions to heparin and if they provided an appropriate definition of infection. Results. The 23 included studies reported data on 2896 patients, who were predominantly adult patients undergoing hemodialysis (16/23 studies), but also adult and pediatric oncology patients, critically ill neonates, and patients receiving total parenteral nutrition. The use of antimicrobial lock solutions led to a 69% reduction in CLABSI rate (relative risk [RR], 0.31; 95% confidence interval [CI],.24-.40) and a 32% reduction in the rate of exit site infections (RR, 0.68; 95% CI,.49-.95) compared with heparin, without significantly affecting catheter failure due to noninfectious complications (RR, 0.83; 95% CI,.65-1.06). All-cause mortality was not different between the groups (RR, 0.84; 95% CI.64-1.12). Neither the type of antimicrobial solution nor the population studied, affected the relative reduction in CLABSIs, which also remained significant among studies reporting baseline infection rates of <1.15 per 1000 catheter-days, and studies providing data for catheter-related bloodstream infections. Publication and selective reporting bias are a concern in our study and should be acknowledged. Conclusions. Antimicrobial lock solutions are effective in reducing risk of CLABSI, and this effect appears to be additive to traditional prevention measures.
KW - CLABSI
KW - CRBSI
KW - central venous catheters
KW - infection
KW - lock
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U2 - 10.1093/cid/ciu671
DO - 10.1093/cid/ciu671
M3 - Article
C2 - 25156111
AN - SCOPUS:84924982279
SN - 1058-4838
VL - 59
SP - 1741
EP - 1749
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 12
ER -