Abstract

INTRODUCTION: Hemodialysis patientsare at increased risk of catheter-related bloodstream infections (CRBSI) and catheter thrombosis asdialysis requires regular access to blood circulation through catheters. Antimicrobial Locking Solutions (ALS) containing anticoagulants and antimicrobial agents (antibiotic/non-antibiotic) are used to seal catheters in order to prevent thrombosis and CRBSI.
 
 PURPOSE: The investigation of internationalclinical studies regarding the efficacy and safety of the various ALS treatments for CRBSI in hemodialysis patients (HD patients) comparing to conventional approaches such as heparin treatment or catheter removal. 
 
 METHODOLOGY: The review included prospective or retrospective clinical studies, randomized clinical trials or cohort studies published since 2015. Publications were retrieved from the “Pubmed”, “Google Scholar” and “Elsevier” databases using ‘catheter’, ‘catheter removal’, ‘hemodialysis’ ‘bacteremia’, ‘antimicrobial lock therapy’as key words.
 
 RESULTS: 17 articles were found to meet the criteria for this systematic review. These studies investigated locking solutions containing various antibiotic (Cefazolin, Gentamicin, Vancomycin, Cotrimoxazole, Daptomycin, Trimethoprim) or/and non-antibiotic agents (Citrate, taurolidine, ethanol, urokinase, Cathasept) +/- anticoagulants, single or in various combinations. The main objective of these studies was to identify the efficacy of ALS with respect to CRBSI risk rates, catheter exchange rates and related adverse effects.
 
 CONCLUSIONS: Antimicrobial Locking Therapy appears significantly beneficial forHD patients as it reduces CRBSI risk and prolongs catheter survival at considerable rates, so it should be seriously considered for systematic useagainst catheter-related infections. Further researchis required to establish safe and effective prevention and therapeutic protocols as alternatives to catheter removal practices.

Highlights

  • Hemodialysis patientsare at increased risk of catheter-related bloodstream infections (CRBSI) and catheter thrombosis asdialysis requires regular access to blood circulation through catheters

  • Antimicrobial Locking Therapy appears significantly beneficial forHD patients as it reduces CRBSI risk and prolongs catheter survival at considerable rates, so it should be seriously considered for systematic useagainst catheter-related infections

  • Citrate-based Antimicrobial Locking Solutions (ALS) +/- antibiotics were found to significantly reduce the risk for CRBSI comparing to heparin locks, without increasing bleeding or catheter thrombosis incidents (Zhao et al, 2014; Böhlke et al, 2015; Mai et al, 2019)

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Summary

Introduction

Hemodialysis patientsare at increased risk of catheter-related bloodstream infections (CRBSI) and catheter thrombosis asdialysis requires regular access to blood circulation through catheters. Purpose: The investigation of internationalclinical studies regarding the efficacy and safety of the various ALS treatments for CRBSI in hemodialysis patients (HD patients) comparing to conventional approaches such as heparin treatment or catheter removal. The appropriate maintenance of central venous catheters (CVC) is integral for the efficacy and safety of hemodialysiswhich requires systematic catheterization for bloodstream access (Dang et al, 2019). Catheter thrombosis or catheter-related bloodstream infections (CRBSI) are common complications for patients undergoing hemodialysis (Sofroniadou et al, 2017). Research in the field of prevention and treatment of CRBSI is imperative for the health management of HD patients.

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