Summary of findings for the main comparison. Antimicrobial lock solutions vs control for preventing catheter‐related infections in patient undergoing haemodialysis.
| Antimicrobial lock solutions vs control for preventing catheter‐related infections in patient undergoing haemodialysis | ||||||
| Patient or population: CVC‐related infection Setting: haemodialysis therapy Intervention: antimicrobial lock solutions Comparison: heparin and other lock solutions | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with heparin and other lock solutions | Risk with antimicrobial lock solutions | |||||
| CVC ‐ related infections assessed with: per 1000 days/catheter | Low | RR 0.38 (0.27 to 0.53) | 2994 (27 RCTs) | ⊕⊕⊝⊝ LOW 1 2 3 4 5 | ||
| 43 per 1.000 | 16 per 1.000 (12 to 23) | |||||
| High | ||||||
| 260 per 1.000 | 99 per 1.000 (70 to 138) | |||||
| Thrombosis assessed with: per 1000 days/catheter | Low | RR 0.79 (0.52 to 1.22) | 2080 (14 RCTs) | ⊕⊝⊝⊝ VERY LOW 6 7 8 9 10 | ||
| 6 per 1.000 | 5 per 1.000 (3 to 7) | |||||
| High | ||||||
| 330 per 1.000 | 261 per 1.000 (172 to 403) | |||||
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio; OR: Odds ratio; | ||||||
| GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect | ||||||
1 This judgment is based on the lack of information regarding the following criteria: random sequence generation, allocation concealment and blinding of outcome assesment
2 the statistics do not show serious heterogeneity and confidence intervals overlap.
3 the evidence is direct because the studies are in hemodialysis patients and the same sealing solutions the question of this review are used.
4 no imprecision is observed; because the decision regarding the use of antimicrobial lock solution is sealed better than heparin along the confidence interval
5 It is suspected a degree of publication bias
6 30% of the studies presented insufficient information to assess citerios of:random sequence generation, allocation concealment and blinding of outcome assesment
7 the statistical test showed a high heterogeneity and the confidence intervals do not overlap
8 the evidence is not indirect because the studies are in hemodialysis patients and the same sealing solutions the question of this review are used.
9 The 95% confidence interval of the pooled estimate ranges from 0.41 to 1.39, which is not narrow enough for a confident judgment of the effect size.
10 Publication bias is suspected as the funnel plot for this outcome shows asymmetry