Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands.
J Hosp Infect. 2022 May;123:143-155. doi: 10.1016/j.jhin.2021.10.022. Epub 2021 Nov 9.
The incidence of central venous catheter (CVC)-related bloodstream infections is high in patients requiring a long-term CVC. Therefore, infection prevention is of the utmost importance. The aim of this study was to provide an updated overview of randomized controlled trials (RCTs) comparing the efficacy of taurolidine containing lock solutions (TL) to other lock solutions for the prevention of CVC-related bloodstream infections in all patient populations. On 15 February 2021, PubMed, Embase and The Cochrane Library were searched for RCTs comparing the efficacy of TLs for the prevention of CVC-related bloodstream infections with other lock solutions. Exclusion criteria were non-RCTs, studies describing <10 patients and studies using TLs as treatment. Risk of bias was evaluated using the Cochrane Risk of Bias 2 tool. A random effects model was used to pool individual study incidence rate ratios (IRRs). Subgroup analyses were performed based on the following factors: CVC indication, comparator lock and bacterial isolates cultured. A total of 14 articles were included in the qualitative synthesis describing 1219 haemodialysis, total parenteral nutrition and oncology patients. The pooled IRR estimated for all patient groups together (nine studies; 918 patients) was 0.30 (95% confidence interval 0.19-0.46), favouring the TLs. Adverse events (10 studies; 867 patients) were mild and scarce. The quality of the evidence was limited due to a high risk of bias and indirectness of evidence. The use of TLs might be promising for the prevention of CVC-related bloodstream infections. Large-scale RCTs are needed to draw firm conclusions on the efficacy of TLs.
在需要长期中央静脉导管（CVC）的患者中，CVC 相关血流感染的发生率很高。因此，感染预防至关重要。本研究旨在提供一个更新的综述，比较含牛磺罗定的锁闭液（TL）与其他锁闭液在所有患者人群中预防 CVC 相关血流感染的疗效的随机对照试验（RCT）。于 2021 年 2 月 15 日，检索了 PubMed、Embase 和 The Cochrane Library 以查找比较 TL 与其他锁闭液预防 CVC 相关血流感染疗效的 RCT。排除标准为非 RCT、描述 <10 例患者的研究和使用 TL 作为治疗的研究。使用 Cochrane 偏倚风险 2 工具评估偏倚风险。使用随机效应模型对个体研究发病率比值比（IRR）进行汇总。基于以下因素进行亚组分析：CVC 适应证、比较锁闭液和培养的细菌分离株。共有 14 篇文章被纳入定性综合分析，描述了 1219 例血液透析、全胃肠外营养和肿瘤患者。汇总所有患者组（9 项研究；918 例患者）的估计合并 IRR 为 0.30（95%置信区间 0.19-0.46），TL 更有优势。不良事件（10 项研究；867 例患者）为轻度且稀少。由于偏倚风险高和证据的间接性，证据质量有限。TL 的使用可能有望预防 CVC 相关血流感染。需要大规模 RCT 来得出关于 TL 疗效的确定结论。
