Risk of dialysis catheter infection according to locking solution

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“Critically ill patients who require renal replacement therapy (RRT) are vulnerable to catheter-related bloodstream infections (CRBSI). This study compared the risk of dialysis catheter infection according to the locking solution in the intensive care unit (ICU).” Parienti et al (2014).

Reference:

Parienti, J.J., Deryckère, S., Mégarbane, B., Valette, X., Seguin, A., Sauneuf, B., Mira, J.P., Souweine, B., Daubin, C. and du Cheyron, D. (2014) Sodium citrate locks and the risk of acute hemodialysis catheter infection among critically ill patients: A quasi-experimental study. Antimicrobial Agents and Chemotherapy. June 30th. [epub ahead of print].

Abstract:

BACKGROUND: Critically ill patients who require renal replacement therapy (RRT) are vulnerable to catheter-related bloodstream infections (CRBSI). This study compared the risk of dialysis catheter infection according to the locking solution in the intensive care unit (ICU).

METHODS: A prospective quasi-experimental study with marginal structural models (MSM) and 2:1 greedy propensity-score matching (PSM) was conducted at nine university-affiliated hospitals and three general hospitals. Five hundred ninety six critically ill patients received either saline or heparin lock solutions (SOC) from 2004-2007 in the Cathedia cohort (n=464 for MSM; n=124 for PSM) or 46.7% citrate lock from 2011-2012 in the citrate (CLock) cohort (n=132 for MSM; n=62 for PSM) to perform RRT using intermittent hemodialysis. Catheter-tip colonization and CRBSI were analyzed.

RESULTS: The mean duration (SD) of catheterization was 7.1 days (6.1) in the SOC group and 7.0 days (5.9) in the CLock group (p=0.84). The risk of dialysis catheter-tip colonization was lower in the CLock group (20.5 versus 38.7 per 1000 catheter-days in the SOC group; hazard ratio (HR) from MSM, 0.73; 95% CI, 0.57-0.93; p<0.02). Consistent findings were found from PSM (HR, 0.46; 95% CI, 0.22-0.95; p<0.04). The risk of CRBSI was non-significantly different in the CLock group (1.1 versus 1.8 per 1000 catheter-days in the SOC group; HR from MSM, 0.48; 95% CI, 0.12-1.87; p=0.29).

CONCLUSIONS: By reducing the risk of catheter-tip colonization, citrate lock has the potential to improve hemodialysis safety in the ICU. Additional studies are warranted before the routine use of citrate locks can be recommended in the ICU.

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