Antimicrobial lock solution systematic review
Abstract:
Objectives: The goal of this systematic review was to determine whether antimicrobial lock (AML) solutions prevent catheter-related bloodstream infections (CRBSI) in children with intestinal failure (IF).
Methods: Electronic databases were searched: Ovid Medline (1946-), Ovid Embase (1974-), Wiley Cochrane Library (inception-) and Web of Science Core Collection via Clarivate Analytics (1900-). Randomized and nonrandomized trials, case or cohort studies that studied any AML solution and used comparator groups were included if they studied children with IF. A meta-analysis compared the rates of CRBSI with AML solutions versus controls, and a Boucher analysis was used to indirectly compare AML solutions.
Results: Twenty-eight studies met eligibility criteria (one open label and 27 observational studies). Quality was good (N=13), fair (N=9) and poor (N=6). All but four studied ethanol and taurolidine. Of 15 ethanol studies, 11 reported a decrease and three reported a trend towards a decreased incidence of CRBSI compared to controls; one reported no difference. Of 9 taurolidine studies, seven reported a decrease and two a trend towards decreased CRBSI rates. There was a decrease in CRBSI with ethanol versus control, (p=0.008) and with taurolidine-citrate versus control (p<0.0005). Using Bucher indirect comparison of the pooled estimates from ethanol versus control to taurolidine versus control, the estimated difference was -0.99 (-4.125, 2.27); p=0.55.
Conclusions: There were no randomized trials and over half of the 28 included studies were fair or poor quality. All but one reported at least a trend towards reduction in CRBSI. AML solutions appear to prevent CRBSI.
Reference:
Gibson B, McNiven C, Sebastianski M, Vandermeer B, Persad R, Robinson JL. Systematic review of antimicrobial lock solutions for prevention of bacteremia in pediatric patients with intestinal failure. J Pediatr Gastroenterol Nutr. 2022 Nov 23. doi: 10.1097/MPG.0000000000003658. Epub ahead of print. PMID: 36730306.