NDT Advance Access published online on July 10, 2009
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfp327
Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections
1 Renal Unit, Churchill Hospital, Oxford 2 Renal Unit, North Middlesex Hospital 3 Renal Unit, Kings College Hospital, London 4 Renal Unit, Royal Berkshire Hospital, Reading 5 Renal Unit, Royal London Hospital, London 6 Department of Medicine and Therapeutics, University of Aberdeen, Aberdeen, UK 7 Department of Nephrology and Hypertension, Henry Ford Health System, Detroit USA
Correspondence and offprint requests to: Kannaiyan S. Rabindranath; E-mail: ksrabi{at}yahoo.co.uk
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Abstract |
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Background. Almost 30% of chronic haemodialysis (HD) patients are dependent on central venous catheters (CVCs) for their vascular access, and catheter-related bacteraemia (CRB) is the major reason for catheter loss and has been associated with substantial morbidity, including meta-static infections. This systematic review evaluates the benefits and harms of antimicrobial interventions for the prevention of catheter-related infections (CRIs).
Methods. MEDLINE (1950–May 2009), EMBASE (1980–May 2009) CENTRAL (up to May 2009) and bibliographies of retrieved articles were searched for relevant RCTs. Analysis was by a random effects model and results expressed as rate ratio, relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI).
Results. A total of 29 trials with 2886 patients and 3005 catheters were included. Antimicrobial catheter locks (AMLs) significantly reduced the rates of CRBs (rate ratio, 0.33, 95% CI 0.24–0.45) and exit-site infections (ESIs) (rate ratio 0.67, 95% CI 0.47–0.96). Exit-site antimicrobial application also significantly reduced the rates of CRBs (rate ratio 0.21, 95% CI 0.12–0.36) and ESIs (rate ratio 0.22, 95% CI 0.10–0.47). Antimicrobial coating of HD catheters and the use of peri-operative antimicrobials did not result in significant reduction in rates of CRBs and ESIs.
Conclusion. The use of AMLs and exit-site antimicrobials are useful measures in the reduction of CRIs, whereas antimicrobial impregnated catheters and peri-operative systemic antimicrobial administration have not been found to be beneficial. Further head-to-head trials of various AMLs and exit-site antimicrobials are needed to know about their comparative clinical efficacy.
Keywords: antimicrobial locks; antimicrobials; bacteraemia; catheter; haemodialysis
Received for publication: 8. 3.08
Accepted in revised form: 12. 6.09