Catheter lock solutions for reducing CRBSI
Abstract:
Background: Different catheter lock solutions (CLSs) are used to reduce catheter-related bloodstream infection (CRBSI) for pediatric patients with central venous catheters (CVCs). But the most effective CLS is unknown.
Aim: To compare the effectiveness of different CLSs for the prevention of CRBSI in pediatric patients.
Methods: Potential studies were searched and selected through the PubMed, Embase, Web of Science and Cochrane library up to May 2021. Randomized controlled trials that assessed the effects of CLSs for preventing CRBSI in pediatric patients were included. We performed a random-effects network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI).
Findings: Thirteen studies comprising 1335 patients were included in the network meta-analysis. Taurolidine+heparin was effective in the prevention of CRBSI compared with heparin in pediatric patients (RR: 0.21, 95%CI: 0.09 – 0.51). No significant difference was found between the other CLSs (such as vancomycin, ethanol, fusidic acid, amikacin, and amikacin and vancomycin) and heparin or between different intervention lock solutions for CRBSI prevention. Based on the surface under the cumulative ranking curve, taurolidine+heparin (85.3%) appeared to be the most effective solution for effectiveness on CRBSI prevention, followed by fusidic acid+heparin (77.0%) and amikacin+heparin (65.7%). There was no statistical global inconsistency among the included studies after design by treatment test (χ2=2.22, P=0.137).
Conclusion: The study showed that taurolidine lock solution seemed to be the most effective for the prevention of CRBSI in pediatric patients. Well-designed randomized trials in pediatric patients are needed to provide more reliable evidences in the effectiveness of different CLSs.
Reference:
Guo Q, Lv Z, Wang H, Song L, Liu Y, Chen H, Zhou C. Catheter Lock Solutions for Reducing Catheter-Related Bloodstream Infections in Pediatric Patients: a network meta-analysis. J Hosp Infect. 2021 Sep 21:S0195-6701(21)00337-6. doi: 10.1016/j.jhin.2021.09.013. Epub ahead of print. PMID: 34560168.