nach oben

International Urology and Nephrology

Erschienen in:

17.04.2018 | Nephrology - Review

Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis

verfasst von: Tingting Zhao, Hong Liu, Jibin Han

Erschienen in: International Urology and Nephrology | Ausgabe 9/2018

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The purpose of this meta-analysis is to evaluate the effect of ethanol lock on the incidence of catheter-related bloodstream infection (CRBSI) in patients with central venous catheters.

Methods

RCTs comparing ethanol lock with another solution lock for prevention of CRBSI were obtained by searching databases of PubMed, Embase, Web of Science and Cochrane Central Register of clinical trials for eligible randomized controlled trials (inception to December 2017). Two researchers separately selected the RCTs and assessed their quality. Data on patient characteristics and ethanol protocols were collected. The primary outcome was the incidence of CRBSI, and the secondary outcomes were catheter colonization, exit infection and thrombosis.

Results

A total of 2575 patients with 3375 catheters from 7 eligible RCTs were included. Overall, ethanol lock significantly decreased the risk of CRBSI, with RR 0.54 (95% CI 0.38–0.78; I² = 0%; p = 0.001); no obvious heterogeneity was observed in the fixed-effects model (I² = 0%). Of note, subgroup analysis demonstrated that ethanol lock conferred significant benefit in studies with tunneled catheters (RR 0.46; 95% CI 0.30–0.72) but not in studies with untunneled catheters. Only two studies provided data regarding catheter colonization, and no significant difference was found (RR, 1.09; 95% CI, 0.87–1.38; I² = 41%; p = 0.45). Moreover, pooled data did not show significant differences between ethanol and control groups with regard to the incidence of thrombosis (RR 1.05; 95% CI 0.91–1.22; I² = 0%; p = 0.48).

Conclusions

Our meta-analysis suggests that ethanol lock is effective on reducing the incidence of CRBSI in hemodialysis patients with tunneled central venous catheters.

Nur mit Berechtigung zugänglich

Mermel LA, Allon M, Bouza E et al (2009) Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 49:1–45CrossRefPubMedPubMedCentral

Rosenthal VD, Guzman S, Migone O et al (2003) The attributable cost, length of hospital stay, and mortality of central line-associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 31:475–480CrossRefPubMed

Renaud B, Brun-Buisson C (2001) Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 163:1584–1590CrossRefPubMed

Siempos II, Kopterides P, Tsangaris I et al (2009) Impact of catheter-related bloodstream infections on the mortality of critically ill patients: a meta-analysis. Crit Care Med 37:2283–2289CrossRefPubMed

Digiovine B, Chenoweth C, Watts C et al (1999) The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit. Am J Respir Crit Care Med 160:976–981CrossRefPubMed

Rello J, Ochagavia A, Sabanes E et al (2000) Evaluation of outcome of intravenous catheter-related infections in critically ill patients. Am J Respir Crit Care Med 162:1027–1030CrossRefPubMed

Goey SH, Verweij J, Bolhuis RL et al (1997) Tunnelled central venous catheters yield a low incidence of septicaemia in interleukin-2-treated patients. Cancer Immunol Immunother 44:301–304CrossRefPubMed

Maki DG, Stolz SS, Wheeler S et al (1994) A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management. Crit Care Med 22:1729–1737CrossRefPubMed

Betjes MG (2011) Prevention of catheter-related bloodstream infection in patients on hemodialysis. Nat Rev Nephrol 7:257–265CrossRefPubMed

10.

Chatzinikolaou I, Finkel K, Hanna H et al (2003) Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter-related infections: a prospective, randomized study. Am J Med 115:352–357CrossRefPubMed

11.

Safdar N, Maki DG (2006) Use of vancomycin-containing lock or flush solutions for prevention of bloodstream infection associated with central venous access devices: a meta-analysis of prospective, randomized trials. Clin Infect Dis 43:474–484CrossRefPubMed

12.

Ramos ER, Reitzel R, Jiang Y et al (2011) Clinical effectiveness and risk of emerging resistance associated with prolonged use of antibiotic-impregnated catheters: more than 0.5 million catheter days and 7 years of clinical experience. Crit Care Med 39:245–251CrossRefPubMed

13.

Dixon JJ, Steele M, Makanjuola AD (2012) Anti-microbial locks increase the prevalence of staphylococcus aureus and antibiotic-resistant enterobacter: observational retrospective cohort study. Nephrol Dial Transplant 27:3575–3581CrossRefPubMed

14.

Balestrino D, Souweine B, Charbonnel N et al (2009) Eradication of microorganisms embedded in biofilm by an ethanol-based catheter lock solution. Nephrol Dial Transplant 24:3204–3209CrossRefPubMed

15.

Qu Y, Istivan TS, Daley AJ et al (2009) Comparison of various antimicrobial agents as catheter lock solutions: preference for ethanol in eradication of coagulase-negative staphylococcal biofilms. J Med Microbiol 58:442–450CrossRefPubMed

16.

Onland W, Shin CE, Fustar S et al (2006) Ethanol-lock technique for persistent bacteremia of long-term intravascular devices in pediatric patients. Arch Pediatr Adolesc Med 160:1049–1053CrossRefPubMed

17.

Oliveira C, Nasr A, Brindle M et al (2012) Ethanol locks to prevent catheter-related bloodstream infections in parenteral nutrition: a meta-analysis. Pediatrics 129:318–329CrossRefPubMed

18.

Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–269CrossRefPubMed

19.

Sanders J, Pithie A, Ganly P et al (2008) A prospective double-blind randomized trial comparing intraluminal ethanol with heparinized saline for the prevention of catheter-associated bloodstream infection in immunosuppressed haematology patients. J Antimicrob Chemother 62:809–815CrossRefPubMed

20.

Slobbe L, Doorduijn JK, Lugtenburg PJ et al (2010) Prevention of catheter-related bacteremia with a daily ethanol lock in patients with tunnelled catheters: a randomized, placebo-controlled trial. PLoS ONE 5:e10840CrossRefPubMedPubMedCentral

21.

Broom JK, Krishnasamy R, Hawley CM et al (2012) A randomized controlled trial of heparin versus ethanol lock therapy for the prevention of catheter associated infection in haemodialysis patients–the healthy-cath trial. BMC Nephrol 13:146CrossRefPubMedPubMedCentral

22.

Worth LJ, Slavin MA, Heath S et al (2014) Ethanol versus heparin locks for the prevention of central venous catheter-associated bloodstream infections: a randomized trial in adult haematology patients with Hickman devices. J Hosp Infect 88:48–51CrossRefPubMed

23.

Pérez-Granda MJ, Barrio JM, Munoz P et al (2014) Ethanol lock therapy (E-Lock) in the prevention of catheter-related bloodstream infections (CR-BSI) after major heart surgery (MHS): a randomized clinical trial. PLoS ONE 9:e91838CrossRefPubMedPubMedCentral

24.

Souweine B, Lautrette A, Gruson D et al (2015) Ethanol lock and risk of hemodialysis catheter infection in critically ill patients. A randomized controlled trial. Am J Respir Crit Care Med 191:1024–1032CrossRefPubMed

25.

Schoot RA, van Ommen CH, Stijnen T et al (2015) Prevention of central venous catheter-associated bloodstream infections in paediatric oncology patients using 70% ethanol locks: a randomised controlled multi-centre trial. Eur J Cancer 51:2031–2038CrossRefPubMed

26.

Safdar N, O’Horo JC, Ghufran A et al (2014) Chlorhexidine-impregnated dressing for prevention of catheter-related bloodstream infection: a meta-analysis*. Crit Care Med 42:1703–1713CrossRefPubMedPubMedCentral

27.

Timsit JF, Bruneel F, Cheval C et al (1999) Use of tunneled femoral catheters to prevent catheter-related infection. A randomized, controlled trial. Ann Intern Med 130:729–735CrossRefPubMed

28.

Randolph AG, Cook DJ, Gonzales CA et al (1998) Tunneling short-term central venous catheters to prevent catheter-related infection: a meta-analysis of randomized, controlled trials. Crit Care Med 26:1452–1457CrossRefPubMed

29.

Weijmer MC, van den Dorpel MA, Van de Ven PJ et al (2005) Randomized, clinical trial comparison of trisodium citrate 30% and heparin as catheter-locking solution in hemodialysis patients. J Am Soc Nephrol 16:2769–2777CrossRefPubMed

30.

Yahav D, Rozen-Zvi B, Gafter-Gvili A et al (2008) Antimicrobial lock solutions for the prevention of infections associated with intravascular catheters in patients undergoing hemodialysis: systematic review and meta-analysis of randomized, controlled trials. Clin Infect Dis 47:83–93CrossRefPubMed

31.

Ho KM, Litton E (2006) Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother 58:281–287CrossRefPubMed

32.

Mermel LA, Alang N (2014) Adverse effects associated with ethanol catheter lock solutions: a systematic review. J Antimicrob Chemother 69:2611–2619CrossRefPubMed

33.

Schilcher G, Schlagenhauf A, Schneditz D et al (2013) Ethanol causes protein precipitation–new safety issues for catheter locking techniques. PLoS ONE 8:e84869CrossRefPubMedPubMedCentral

34.

Abu-El-Haija M, Schultz J, Rahhal RM (2014) Effects of 70% ethanol locks on rates of central line infection, thrombosis, breakage, and replacement in pediatric intestinal failure. J Pediatr Gastroenterol Nutr 58:703–708PubMed

Titel: Ethanol lock is effective on reducing the incidence of tunneled catheter-related bloodstream infections in hemodialysis patients: a systematic review and meta-analysis
verfasst von: Tingting Zhao
Hong Liu
Jibin Han
Publikationsdatum: 17.04.2018
Verlag: Springer Netherlands
Erschienen in: International Urology and Nephrology / Ausgabe 9/2018
Print ISSN: 0301-1623
Elektronische ISSN: 1573-2584
DOI: https://doi.org/10.1007/s11255-018-1855-4

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

25.04.2024 Hypotonie Nachrichten

Wenn unter einer medikamentösen Hochdrucktherapie der diastolische Blutdruck in den Keller geht, steigt das Risiko für schwere kardiovaskuläre Ereignisse: Darauf deutet eine Sekundäranalyse der SPRINT-Studie hin.

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 9/2018

Topical rectal antiseptic at time of prostate biopsy: how a resident patient safety project has evolved into institutional practice

Is the plasma endocan level a reliable predictor for the severity of erectile dysfunction?

Letter to the editor

Atrial fibrillation in dialysis patients: is there a place for non-vitamin K antagonist oral anticoagulants?

Serum bilirubin level and its impact on the progression of chronic kidney disease

Low serum butyrylcholinesterase is independently related to low fetuin-A in patients on hemodialysis: a cross-sectional study