Abstract
Introduction: Catheter-related bloodstream infection (CRBSI) is a common complication of catheter use for vascular access in hemodialysis patients and a major cause of morbidity and mortality. Preventive measures, including antibiotic lock, are inadequate due to the risk of resistance and insufficient effect against bacterial biofilm. Ethanol, an antimicrobial substance, is a potential prophylactic lock-in preventing CRBSI. This study aims to assess ethanol lock's effectiveness in preventing CRBSI in hemodialysis patients with a catheter as vascular access and its impact on catheter dysfunction. Methods: Researchers systematically searched online databases including Pubmed, Cochrane Library, and Science Direct for relevant randomized controlled trials (RCTs) published within 2011 until 2020. Relevant data were pooled in PICOs (Population, Intervention, Control, Outcomes) format and analyzed with Review Manager (version 5.3.5, Cochrane Collaboration, Denmark). Results: Seven RCTs involving 453 patients were assessed. The primary outcome indicates that prophylactic ethanol lock significantly reduces the incidence of CRBSI compared to that of heparin lock (RR=0.32, 95% CI 0.12-0.83, p=0.02, heterogeneity I2=68%). The secondary outcome suggests no significant difference in the incidence of catheter dysfunction in ethanol lock and heparin lock (RR=0.75, 95% CI 0.23-2.40, p=0.63, heterogeneity I2=68%). Conclusion: Ethanol is a potential prophylactic lock agent in preventing CRBSI in hemodialysis patients with catheter access. Further research is needed to synchronize the procedural use of ethanol lock and evaluate its long-term effect.
Highlights
Catheter-related bloodstream infection (CRBSI) is a common complication of catheter use for vascular access in hemodialysis patients and a major cause of morbidity and mortality
This study aims to evaluate the potency of ethanol lock in preventing CRBSI in hemodialysis patients in the form of metaanalysis from available clinical trials
This study aims to evaluate the effect of ethanol lock in the incidence of CRBSI compared to heparin lock in hemodialysis patients as a primary outcome and the effect of ethanol lock in catheter dysfunction as a secondary outcome
Summary
Catheter-related bloodstream infection (CRBSI) is a common complication of catheter use for vascular access in hemodialysis patients and a major cause of morbidity and mortality. An antimicrobial substance, is a potential prophylactic lock-in preventing CRBSI. This study aims to assess ethanol lock’s effectiveness in preventing CRBSI in hemodialysis patients with a catheter as vascular access and its impact on catheter dysfunction. The primary outcome indicates that prophylactic ethanol lock significantly reduces the incidence of CRBSI compared to that of heparin lock (RR=0.32, 95% CI 0.12-0.83, p=0.02, heterogeneity I2=68%). Conclusion: Ethanol is a potential prophylactic lock agent in preventing CRBSI in hemodialysis patients with catheter access. Around 3 million of them require hemodialysis (HD).[1] In Indonesia, according to The Indonesian Renal Registry (IRR), the number of CKD patients increased from 9.649 in 2010 to 30.831 in 2017, while the prevalence increased from 11.484 in 2010 to 77.892 in 2017.2 Hemodialysis, in Indonesia, remains the main treatment modality. In the dialysis unit on Dr Soetomo District Hospital Surabaya, the recorded number of CKD patients who undergo routine hemodialysis constantly increased for three years: 245 patients in 2013, 255 patients in 2014, and 303 patients in 2015.3
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
