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1 July 2008

Volume 47, Number 1
Clinical Infectious Diseases 2008;47:83–93
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4701-0014$15.00
DOI: 10.1086/588667
MAJOR ARTICLE

Antimicrobial Lock Solutions for the Prevention of Infections Associated with Intravascular Catheters in Patients Undergoing Hemodialysis: Systematic Review and Meta‐analysis of Randomized, Controlled Trials

Dafna Yahav,1,5,a

Benaya Rozen‐Zvi,2,5,a

Anat Gafter‐Gvili,3,5

Leonard Leibovici,1,5

Uzi Gafter,2 and

Mical Paul4,5

Departments of 1Medicine E, 2Nephrology, and 3Hematology and 4Infectious Disease Unit, Rabin Medical Center, Beilinson Campus, Petah‐Tiqva, and 5Sackler School of Medicine, Tel Aviv University, Ramat Aviv, Israel

Background.Prevention of catheter‐related bloodstream infections in patients undergoing hemodialysis by use of antimicrobial catheter lock solutions has been examined in several trials, but no consensus is available for clinical practice.

Methods.A systematic review and meta‐analysis were performed of randomized controlled trials that compared single or combination antimicrobial catheter lock solutions with heparin or another antimicrobial for the prevention of infections in patients undergoing hemodialysis. The primary outcomes assessed were bloodstream infections, catheter‐related bloodstream infections, and the need for catheter removal. Relative risks with 95% confidence intervals (CIs) for individual trials were pooled.

Results.Eleven trials (924 patients) that assessed antibiotic catheter lock solutions and 5 trials (661 patients) that assessed nonantibiotic antimicrobial catheter lock solutions met inclusion criteria. None of the trials assessed all bloodstream infections. Antibiotic catheter lock solutions significantly reduced catheter‐related bloodstream infections (relative risk, 0.44; 95% CI, 0.38–0.50). Significant heterogeneity for this outcome could be explained by smaller effect estimates in larger trials that reported adequate randomization methods (relative risk, 0.60; 95% CI, 0.54–0.67). Efficacy was higher when additional preventive measures were used and to prevent the first episode of catheter‐related bloodstream infection. Catheter removal rates were significantly reduced (relative risk, 0.35; 95% CI, 0.23–0.55). Resistance development was documented in a single patient. Data concerning nonantibiotic antimicrobial lock solutions were limited and heterogenous. High‐quality trials that used additional preventive measures showed a significant reduction in catheter‐related bloodstream infections (relative risk, 0.25; 95% CI, 0.13–0.50).

Conclusions.Antibiotic catheter lock solutions reduce catheter‐related bloodstream infections, with a number needed to treat of 4 patients (95% CI, 4–5), and catheter removal rates in patients undergoing hemodialysis. The use of antibiotic catheter lock solutions should be considered in routine clinical practice in conjunction with other prevention modalities.

Received 3 December 2007; accepted 22 February 2008; electronically published 22 May 2008.

Reprints and correspondence: Dr. Dafna Yahav, Dept. of Medicine E, Rabin Medical Center, Beilinson Campus, 49100 Petah‐Tiqva, Israel ().

Cited by

K. Sauer, J. Steczko, S. R. Ash. (2009) Effect of a solution containing citrate/Methylene Blue/parabens on Staphylococcus aureus bacteria and biofilm, and comparison with various heparin solutions. Journal of Antimicrobial Chemotherapy 63:5, 937-945
Online publication date: 5-Apr-2009.
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Miguel A Vazquez. (2009) Vascular access for dialysis: recent lessons and new insights. Current Opinion in Nephrology and Hypertension 18:2, 116-121
Online publication date: 1-Apr-2009.
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M. Hollenbeck, V. Mickley, J. Brunkwall, H. Daum, P. Haage, J. Ranft, R. Schindler, P. Thon, D. Vorwerk. (2009) Gefäßzugang zur Hämodialyse. Der Nephrologe 4:2, 158-176
Online publication date: 1-Apr-2009.
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Gerald A. Beathard, Aris Urbanes. (2008) Infection Associated with Tunneled Hemodialysis Catheters. Seminars in Dialysis 21:6, 528-538
Online publication date: 1-Dec-2008.
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  • D.Y. and B.R.‐Z. contributed equally to this article.

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