From the Department of Internal Medicine, Division of Nephrology, University of Mississippi Medical Center, Jackson, Mississippi.
Faculty of Medicine, Fayoum University, Fayoum, Egypt.
ASAIO J. 2021 Oct 1;67(10):1079-1086. doi: 10.1097/MAT.0000000000001382.
Catheter-related bloodstream infection (CRBSI) with hemodialysis catheters are associated with increased mortality, morbidity and pose significant financial burden on healthcare. Antibiotic and antimicrobial locking solutions are effective in reducing risk of CRBSI. From inception to April 2020, we looked for relevant clinical controlled trials throughout the following databases: EBSCO, PubMed, Cochrane CENTRAL, MEDLINE, EMBASE, clinicaltrial.gov, and Google Scholar performing a metanalysis comparing antibiotic and antimicrobial lock solutions to heparin. Twenty-six studies with 4,967 patients reported the incidence of catheter-related bacteremia (CRB). The overall pooled risk ratio (RR) showed that the intervention group was associated with a significantly lower incidence of CRB by 30% compared with heparin (RR = 0.30, 95% confidence interval [CI] [0.25, 0.36], p < 0.001). Subgroup analysis showed that administration of antibiotic regimens led to a decreased risk of CRB episodes by 28% compared with the heparin group (RR = 0.28, 95% CI [0.21, 0.37], p < 0.0001). Antimicrobial solutions was associated with reduced risk of CRB by 32% compared with patients of the control group (RR = 0.32, 95% CI [0.25, 0.41], p < 0.0001). A test of subgroup differences was revealed no significant favoring of any of the two interventions. Both antibiotic and antimicrobial solutions are effective in reducing CRBSI.
导管相关血流感染（CRBSI）与血液透析导管相关，与死亡率、发病率增加有关，并对医疗保健造成重大经济负担。抗生素和抗菌锁定溶液可有效降低 CRBSI 的风险。从 2020 年 4 月开始，我们在以下数据库中寻找相关的临床对照试验：EBSCO、PubMed、Cochrane 中央、MEDLINE、EMBASE、clinicaltrial.gov 和 Google Scholar，对比较抗生素和抗菌锁定溶液与肝素的研究进行荟萃分析。26 项研究共 4967 例患者报告了导管相关菌血症（CRB）的发生率。总体汇总风险比（RR）表明，与肝素相比，干预组的 CRB 发生率显著降低 30%（RR = 0.30，95%置信区间 [CI] [0.25, 0.36]，p < 0.001）。亚组分析表明，与肝素组相比，抗生素方案的管理导致 CRB 发作的风险降低了 28%（RR = 0.28，95%CI [0.21, 0.37]，p < 0.0001）。与对照组相比，抗菌溶液可使 CRB 的风险降低 32%（RR = 0.32，95%CI [0.25, 0.41]，p < 0.0001）。亚组差异检验显示，两种干预措施均无明显优势。抗生素和抗菌溶液都能有效降低 CRBSI。
