Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections

Kannaiyan S. Rabindranath, Tarun Bansal, James Adams, Ruma Das, Ranjit Shail, Alison Murray MacLeod, Carol Moore, Anatole Besarab

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)3763-3774
Number of pages12
JournalNephrology Dialysis Transplantation
Volume24
Issue number12
Early online date10 Jul 2009
DOIs
Publication statusPublished - Dec 2009

Keywords

  • antimicrobial locks
  • antimicrobials
  • bacteraemia
  • catheter
  • haemodialysis
  • ANTIBIOTIC LOCK TECHNIQUE
  • BLOOD-STREAM INFECTIONS
  • VASCULAR ACCESS
  • CONTROLLED-TRIAL
  • CLINICAL-TRIAL
  • TUNNELED CATHETERS
  • POVIDONE-IODINE
  • CITRATE LOCK
  • BACTEREMIA
  • DIALYSIS

Cite this

Rabindranath, K. S., Bansal, T., Adams, J., Das, R., Shail, R., MacLeod, A. M., ... Besarab, A. (2009). Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections. Nephrology Dialysis Transplantation, 24(12), 3763-3774. https://doi.org/10.1093/ndt/gfp327

Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections. / Rabindranath, Kannaiyan S.; Bansal, Tarun; Adams, James; Das, Ruma; Shail, Ranjit; MacLeod, Alison Murray; Moore, Carol; Besarab, Anatole.

In: Nephrology Dialysis Transplantation, Vol. 24, No. 12, 12.2009, p. 3763-3774.

Research output: Contribution to journalArticle

Rabindranath, KS, Bansal, T, Adams, J, Das, R, Shail, R, MacLeod, AM, Moore, C & Besarab, A 2009, 'Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections', Nephrology Dialysis Transplantation, vol. 24, no. 12, pp. 3763-3774. https://doi.org/10.1093/ndt/gfp327
Rabindranath, Kannaiyan S. ; Bansal, Tarun ; Adams, James ; Das, Ruma ; Shail, Ranjit ; MacLeod, Alison Murray ; Moore, Carol ; Besarab, Anatole. / Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections. In: Nephrology Dialysis Transplantation. 2009 ; Vol. 24, No. 12. pp. 3763-3774.
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abstract = "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.",
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AU - Rabindranath, Kannaiyan S.

AU - Bansal, Tarun

AU - Adams, James

AU - Das, Ruma

AU - Shail, Ranjit

AU - MacLeod, Alison Murray

AU - Moore, Carol

AU - Besarab, Anatole

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N2 - 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.

AB - 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.

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KW - BLOOD-STREAM INFECTIONS

KW - VASCULAR ACCESS

KW - CONTROLLED-TRIAL

KW - CLINICAL-TRIAL

KW - TUNNELED CATHETERS

KW - POVIDONE-IODINE

KW - CITRATE LOCK

KW - BACTEREMIA

KW - DIALYSIS

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