Abstract
Patients on home parenteral nutrition (HPN) are dependent on central venous access for long-term sustenance, and catheter-related bloodstream infections (CRBSIs) are a major cause of morbidity and mortality in this patient population. As such, there is much interest in finding new methods for preventing CRBSIs in patients on HPN. As it is thought that these infections are preceded by microbial colonization of the catheter, one approach is to use antimicrobial catheter lock solutions. Although antibiotic catheter lock solutions have been present for decades, their use has been mostly limited to the treatment of CRBSIs due to concern for promoting microbial resistance. Recently, however, with the advent of non-antibiotic antimicrobial catheter lock solutions, this approach is gaining popularity as a promising method to decrease rates of CRBSI in HPN patients.
Highlights
Parenteral nutrition is a life-sustaining therapy required in patients who do not have a functioning gastrointestinal tract
Many efforts have been made to reduce the risk of catheter-related bloodstream infections (CRBSIs) including: education in aseptic technique, application of topical antimicrobial agents to the exit site, and reducing the number of manipulations of the catheter and solutions for infusion
There are several non-antibiotic catheter lock solutions that can be used for antimicrobial prophylaxis, including citrate, ethanol, taurolidine, and tetrasodium Ethylenediamine Tetraacetic Acid (EDTA)
Summary
Parenteral nutrition is a life-sustaining therapy required in patients who do not have a functioning gastrointestinal tract. This can be either second to surgical removal, or malfunction (such as in malabsorptive conditions and dysmotility). Many efforts have been made to reduce the risk of catheter-related bloodstream infections (CRBSIs) including: education in aseptic technique, application of topical antimicrobial agents to the exit site, and reducing the number of manipulations of the catheter and solutions for infusion. Antimicrobial catheter lock solutions are used in hemodialysis catheters [2] but reviewing this is beyond the scope of this paper The aim of this scoping review is to discuss the various non-antibiotic catheter lock solutions, their potential role for CRBSI prophylaxis in HPN patients and to identify the need for further research in this area
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