Table 2.
Pooled outcomes from trials of catheter lock solutions that can be used selectively for CRBSI prophylaxis.
| Agents Studied, Reference | Patients (n) | Incidence Rate Ratio (IRR) (95% CI) | P value | Anticipated Incidence of CRBSI (95% CI) |
Tunneled catheters, % | Follow-up period | |
|---|---|---|---|---|---|---|---|
| Intervention Group | Control Group | ||||||
| Citrate 4% [34–36] (3 CCTs) | 675 | 0.59 (0.41–0.85) | 0.005 | Citrate 4%: 0.7/1000 cath.days | Heparin (5000 U/ml): 1.2/1000 cath.days | Tunneled catheters, 100% | 12 months or until catheter removal |
| Citrate30% [40] (1 RCT) | 291 | 0.26 (0.13–0.55) | 0.0001 | Citrate 30%: 1.1/1000 cath.days | Heparin (5000 U/ml): 4.1/1000 cath.days | Tunneled catheters, 34% | until catheter removal |
| Citrate 46.7% [41] (1 CCT) | 65 | 0.05 (0.01–0.40) | <0.0001 | Citrate 46.7%: 0.2/1000 cath.days | Heparin (1500 U/ml): 3.3/1000 cath.days | Tunneled catheters, 100% | until catheter removal |
| Citrate 5% [44] (1 CCT) | 28 | 0.59 (0.29–1.19) | 0.137 | 5% sodium citrate: 1.33% | 10% sodium citrate: 2.25% | Tunneled catheters, 100% | 3 months |
| EDTA/Ethanol-Ca-EDTA [51,52] (2 RCTs) | 387 | 0.29 (0.10–0.89) | 0.0311 | EDTA/Ethanol-Ca-EDTA: 0.1/1000 cath.days | Heparin (5000 U/ml): 0.5/1000 cath.days | Tunneled catheters, 93.8% | 3- 8months or until catheter removal |
| Weekly rt-PA [57] (1 RCT) | 225 | 0.29 (0.12–0.79) | 0.011 | rt-PA once weekly: 0.40 episodes/1000 patient-days | Heparin (5000 U/ml): 1.37 episodes/1000 patient-days | Tunneled catheters, 100% | 6 months |
| Gentamicin (≧ 4mg/ml) [78,80,82] (3 RCTs) | 203 | 0.06 (0.01–0.23) | <0.0001 | Gentamicin + anticoagulant: 0.2/1000 cath.days | Heparin/Tau 1.35%-citrate 4%: 4.0/1000 cath.days | Tunneled catheters, 53.1% | 3 months or until catheter removal |
| Gentamicin (0.32 mg/ml) [84–85] (1 RCT + 1 CCT) | 858 | 0.26 (0.19–0.37) | <0.0001 | Gentamicin + anticoagulant: 0.4/1000 cath.days | Heparin (1000 U/ml): 1.5/1000 cath.days | Tunneled catheters, 100% | until catheter removal |
| Cefazolin + Gentamicin [90,91] (1 RCT + 1 CCT) | 390 | 0.31 (0.19–0.50) | 0.0001 | Cefazolin + gentamicin + Heparin: 0.6/1000 cath.days | Heparin (1000 U/ml): 1.8/1000 cath.days | Tunneled catheters, 100% | 7 months or until catheter removal |
| Vancomycin + heparin/gentamicin [87,88] (1 RCT + 1 CCT) | 163 | 0.16 (0.06–0.42) | <0.0001 | Vancomycin + Heparin/gentamicin: 0.50/1000 HD sessions | Routine TCC management/Heparin: 2.9/1000 HD sessions | Tunneled catheters, 100% | 12 months |
| Cefotaxime + heparin [48,94,95] (2 RCTs + 1 CCT) | 316 | 0.44 (0.34–0.57) | <0.0001 | Cefotaxime + heparin: 1.6/1000 cath.days | Heparin (5000 U/ml): 3.6/1000 cath.days | Tunneled catheters, 100% | 12 months |
| Minocycline + EDTA [97] (1 RCT) | 204 | 0.26 (0.10–0.70) | 0.0043 | Minocycline + EDTA: 1.1/1000 cath.days | Heparin (5000 U/ml): 4.3/1000 cath.days | Tunneled catheters, 27.8% | 3 months |
| Cotrimoxazole + heparin [98] (1 RCT) | 87 | 0.19 (0.04–0.86) | 0.0230 | Cotrimoxazole + Heparin: 0.58/1000 cath.days | Heparin (2500 U/ml): 4.4/1000 cath.days | Tunneled catheters, 100%% | 12 months |
| TaurolockTM [101–104] (3 RCTs) | 218 | 0.35 (0.18–0.66) | 0.0008 | 1.35% Taurolidine + 4% citrate: 1.1/1000 cath.days | Heparin (5000 U/ml): 3.0/1000 cath.days | Tunneled catheters, 79.4% | 3 months or until catheter removal |
| TauroLock™-HEP500 [92,105] (2 CCTs) | 301 | 0.84 (0.53–1.36) | 0.48 | 1.35%Taurolidine + 4% citrate + Heparin (500 U/ml): 1.2/1000 cath.days | TauroLock™/antibiotic + Heparin /Heparin: 1.4/1000 cath.days | Tunneled catheters, 100%% | 15 months or until catheter removal |
| TauroLock™-U25,000 [107–109] (3 RCTs) | 351 | 0.34 (0.16–0.77) | 0.0064 | 1.35%Taurolidine + 4% citrate + urokinase (25000 U) once weekly: 0.3/1000 cath.days | TaurolockHEP/4% citrate: 0.9/1000 cath.days | Tunneled catheters, 100%% | 6 months or until catheter removal |
| Taurolock™ vs Antibiotic [92,103] (1 RCT + 1 CCT) | 246 | 1.42 (0.75–2.79) | 0.29 | Taurolidine + citrate 4% /+Heparin: 1.5/1000 cath.days | Antibiotic + Heparin: 1.1/1000 cath.days | Tunneled catheters, 100%% | 3 months or 15 months |
| Ethanol70%/+Heparin [111–114] (4 RCTs) | 568 | 0.43 (0.23–0.78) | 0.0068 | Ethanoll70%/+Heparin: 0.8/1000 cath.days | Heparin/placebo: 1.8/1000 cath.days | Tunneled catheters, 100% | until catheter removal |
| Hypertonic saline [115] (1 RCT) | 56 | 0.92 (0.21–3.94) | 0.54 | 26% NaCl + Heparin: 1.1/1000 cath.days | Standard Heparin: 0.96/1000 cath.days | Tunneled catheters, 100% | until catheter removal |
| 7.5% NaHCO3 [118,119] (2 RCTs) | 278 | 0.07 (0.0066–0.394) | 0.0004 | 7.5% NaHCO3: 0.1/1,000 cath.days | Heparin (2500 U/ml): 1.9/1,000 cath.days | Tunneled catheters, 42.4% | 6 weeks or until catheter removal |