Document Detail


A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection.
MedLine Citation:
PMID:  18215701     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Catheter-related infection (CRI) is associated with increased all-cause mortality and morbidity in hemodialysis patients and may be reduced by using antimicrobial lock solutions (ALSs). STUDY DESIGN: We performed a meta-analysis of studies identified from a search conducted in February 2007 of the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, databases of ongoing trials, major renal journals, and reference lists of relevant reports. SETTING & POPULATION: Patients receiving acute or long-term hemodialysis through a tunneled or nontunneled central venous catheter. SELECTION CRITERIA FOR STUDIES: We included all prospective randomized studies that compared ALS with heparin. INTERVENTION: Administration of antibiotic and/or antimicrobial catheter locking solution. OUTCOME MEASURES: Primary outcome was CRI rate in patients using ALSs compared with those using heparin alone. We also examined effects of ALS use on mortality, adverse events, and catheter thrombosis. RESULTS: 7 studies were identified with a total of 624 patients and 819 catheters (448 tunneled, 371 nontunneled). CRI was 7.72 (95% confidence interval, 5.11 to 10.33) times less likely when using ALS. There were no consistent suggestions of adverse outcomes with ALS use; in particular, rates of catheter thrombosis did not increase. There was no evidence of antibiotic resistance developing during a maximum follow-up of 12 months. LIMITATIONS: The major limitation of this review is the relatively short duration of follow-up of the included studies, which does not allow complete reassurance regarding the development of antibiotic resistance. Lack of direct comparisons means that determination of the most efficient ALS is not possible. CONCLUSIONS: This review confirms that antibiotic locking solutions reduce the frequency of CRI without significant side effects.
Authors:
Yasmin Jaffer; Nicholas M Selby; Maarten W Taal; Richard J Fluck; Christopher W McIntyre
Publication Detail:
Type:  Journal Article; Meta-Analysis    
Journal Detail:
Title:  American journal of kidney diseases : the official journal of the National Kidney Foundation     Volume:  51     ISSN:  1523-6838     ISO Abbreviation:  Am. J. Kidney Dis.     Publication Date:  2008 Feb 
Date Detail:
Created Date:  2008-01-24     Completed Date:  2008-02-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8110075     Medline TA:  Am J Kidney Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  233-41     Citation Subset:  IM    
Affiliation:
Department of Renal Medicine, Derby City Hospital, UK.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Anti-Bacterial Agents / therapeutic use*
Anticoagulants / therapeutic use
Bacterial Infections / etiology*,  mortality,  prevention & control*
Catheterization, Peripheral / instrumentation*
Catheters, Indwelling / adverse effects*
Drug Resistance, Bacterial
Female
Hemodiafiltration / instrumentation*
Heparin / therapeutic use
Humans
Male
Middle Aged
Randomized Controlled Trials as Topic
Renal Dialysis / mortality
Research Design
Thrombosis / etiology,  prevention & control
Time Factors
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Anticoagulants; 9005-49-6/Heparin
Comments/Corrections
Comment In:
Am J Kidney Dis. 2008 Feb;51(2):165-8   [PMID:  18215693 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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