A meta-analysis of hemodialysis catheter locking solutions in the prevention of catheter-related infection

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. Am J Kidney Dis 51:233-241. (c) 2008 by the National Kidney Foundation, Inc.