Abstract
BackgroundCurrent evidence regarding the efficacy of ethanol locks in preventing catheter-related bloodstream infection (CRBI) is inconclusive.MethodsElectronic databases, including PubMed, Web of Science, Embase, and the Cochrane Library (until April 2018),were systematically searched for relevant studies. Two reviewers independently screened the retrieved records and identified RCTs that met the inclusion criteria. Relevant data were extracted for pooled analyses using Review Manager 5.3 software. Subgroup analysis was performed according to the study quality, duration of the ethanol lock, disease type and CRBI definition. Eggs’ method was applied to detect publication bias. Sensitivity analysis was conducted to check the stability of the meta-analysis results.ResultsTen RCTs involving 2760 patients were included in the analysis. The overall pooled result indicated that ethanol locks significantly reduced the incidence of CRBI (RR 0.66, 95% CI 0.51–0.86). Subgroup analysis suggested that an ethanol lock significantly decreased the incidence of CRBI in patients with hematological diseases (RR 0.50, 95% CI 0.31–0.80). An ethanol lock significantly reduced the incidence of CRBI in a2-hour ethanol lock group (RR 0.49, 95% CI 0.33–0.73). The meta-analysis showed that an ethanol lock significantly reduced the incidence of CRBI according to analysis of high-(RR 0.66, 95% CI 0.47–0.94) or low-(RR 0.66, 95% CI 0.46–0.95) quality studies. Meta-analysis of studies with a strict CRBI definition showed that an ethanol lock can significantly prevent CRBI (RR 0.61, 95% CI 0.42–0.89). The results of sensitivity analysis suggested that the pooled result was stable. Meta-analysis of adverse events showed that an ethanol lock did not increase the incidence of thrombosis (RR 1.05, 95% CI 0.51–2.18) or mortality (RR 0.99, 95% CI 0.90–1.08) but did result in increased nausea (RR 1.54, 95% CI 1.01–2.35), dizziness (RR 4.21, 95% CI 2.40–7.39),elevated blushing rates (RR 3.27, 95% CI 2.05–5.22) and altered taste rates (RR 2.61, 95% CI 1.93–3.54).ConclusionsAn ethanol lock may play a role in the prevention of CRBI, especially in immunocompromised patients with hematological diseases.
Highlights
Current evidence regarding the efficacy of ethanol locks in preventing catheter-related bloodstream infection (CRBI) is inconclusive
Subgroup analysis showed that an ethanol lock can reduce the incidence of CRBI in patients with hematological diseases (RR 0.50, 95% Confidence interval (CI) 0.31 to 0.80, I2 = 0%, Fig. 3)
There was no significant difference between less than 20-min ethanol lock and conventional catheter care groups (RR 0.84, 95% CI 0.59 to 1.19), again without significant heterogeneity (I2 = 0%, Fig. 5), or48-hour ethanol lock and conventional catheter care groups (RR 1.29, 95% CI 0.37 to 4.47).Meta-analysis of studies with a strict CRBI definition revealed that an ethanol lock can significantly prevent CRBI (RR 0.61, 95% CI 0.42– 0.89),though pooled analysis of studies with a less strict CRBI definition suggested no significant change in the incidence of CRBI between ethanol lock and control lock groups (RR 0.65, 95% CI 0.39–1.07) (Fig. 6)
Summary
Current evidence regarding the efficacy of ethanol locks in preventing catheter-related bloodstream infection (CRBI) is inconclusive. Despite improved international guidelines on CVC placement and catheter care, the use of CVCs carries a high risk of developing catheter-related bloodstream infection (CRBI) [2]. CRBIs are related to increased healthcare costs, morbidity, hospitalization and death [3]. There are many ways to reduce CRBIs, including antimicrobial lock solutions, catheter care procedures, and agents that reduce nasal colonization of Staphylococcus aureus, and one meta-analysis showed that antimicrobial lock solutions significantly reduce the risk of CRBI [4]. Ethanol locks are considered a promising lock solutions because they are inexpensive, universally available, and effective against a broad spectrum of bacteria and fungi [5]. Study results to date on ethanol locks are controversial
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