Haq Ayesha, Patel Deepkumar, Gutlapalli Sai Dheeraj, Hernandez Grethel N, Seffah Kofi D, Zaman Mustafa Abrar, Awais Nimra, Satnarine Travis, Ahmed Areeg, Khan Safeera
Internal Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Family Medicine, California Institute of Behavioral Neurosciences and Psychology, Fairfield, USA.
Cureus. 2023 Sep 10;15(9):e45000. doi: 10.7759/cureus.45000. eCollection 2023 Sep.
Central venous catheter (CVC)-based hemodialysis is a major contributor to bacteremia in immunocompromised hosts. Heparin-locking CVCs is a frequent therapeutic procedure. However, it has not been shown to reduce catheter-related bloodstream infections (CRBSIs). For this systematic review, we searched PubMed, PubMed Central, ResearchGate, Science Direct, and Multidisciplinary Digital Publishing Institute (MDPI) for multiple articles published between January 2018 and January 2023 to determine how antimicrobial locking solutions affect CRBSIs, which could ultimately lower the risk of morbidity, mortality, and hospitalization costs. Antilocking products, catheter-related bacteremia, central-line associated bloodstream infections, tunneled dialysis catheter, hemodialysis, antibiotic, and antimicrobial catheter locks, and the Medical Subject Heading (MeSH) method for PubMed were used as the main keywords for searching publications. A pool of 13 studies with 46,139 individuals showed that the therapy group had a lower incidence of CRBSIs than the heparin-treated control group. Furthermore, it was discovered that bacteria were resistant to gentamicin, and the use of antibiotics had no discernible impact on catheter malfunction. In conclusion, the most effective locking solution to date is an antilocking solution made up of an antibiotic or antimicrobial agent combined with low-dose heparin (500-2,500 U/mL).
基于中心静脉导管（CVC）的血液透析是免疫功能低下宿主发生菌血症的主要原因。肝素封管CVC是一种常见的治疗方法。然而，尚未证明其能减少导管相关血流感染（CRBSI）。在本系统评价中，我们检索了PubMed、PubMed Central、ResearchGate、ScienceDirect和多学科数字出版研究所（MDPI），查找2018年1月至2023年1月期间发表的多篇文章，以确定抗菌封管溶液如何影响CRBSI，这最终可能降低发病风险、死亡率和住院费用。抗菌封管产品、导管相关菌血症、中心静脉相关血流感染、带隧道的透析导管、血液透析、抗生素和抗菌导管封管，以及PubMed的医学主题词（MeSH）方法被用作检索出版物的主要关键词。一项纳入46139人的13项研究表明，治疗组的CRBSI发生率低于肝素治疗的对照组。此外，还发现细菌对庆大霉素耐药，且使用抗生素对导管故障没有明显影响。总之，迄今为止最有效的封管溶液是由抗生素或抗菌剂与低剂量肝素（500 - 2500 U/mL）组成的抗菌封管溶液。
