Antibiotic Lock Technique: Review of the Literature

Abstract

Central venous catheters (CVCs) are frequently used for patients requiring long-term venous access. Catheter-related infection is a serious complication associated with extended use of a CVC and can result in catheter removal. The antibiotic lock technique, a controversial method for sterilizing the catheter lumen, involves instilling high concentrations of antibiotics with or without heparin into the catheter lumen for extended periods of time. Studies differ regarding the choice and concentrations of antibiotics, dwell times in the catheter lumen, presence of heparin in the antibiotic lock technique solution, use of systemic antibiotics with the technique, and use of the technique for prevention or treatment of catheter-related infections. Results of in vitro studies demonstrate that many antibiotic combinations are stable and maintain high drug concentrations for prolonged periods of time. In vivo studies report the success of multiple combinations for both prevention and treatment with antibiotic lock technique in salvaging these catheters.

Accuracy of bacterial DNA testing for central venous catheter-associated bloodstream infection in children with cancer

“…We found four systematic reviews, 73,75,80,81 one other review, 34 and four comparative studies (see Table 12). 36,78,79,82 One of these was excluded as the authors compared different types of antimicrobial lock solutions.…”

“…5,73,74,77,[106][107][108][109][110][111][112][113][114][115][116] Two of these reviews 77,106 contained 21 of 24 RCTs included in our review. Scrutiny of published guidelines did not yield additional studies.…”

“…Antibiotic lock solutions can achieve much higher levels of antibiotic within the CVC lumen than could be safely achieved within the bloodstream. 34,[73][74][75] The lock solution is left in the CVC until the next time the lumen needs to be used for fluid or drug administration to the patient, usually for at least 2 hours, though dwell times from 20-60 minutes up to several days have been reported. 76 Recommended practice is to withdraw and discard the lock solution before using the CVC again for infusion or administration of drugs in order to avoid adverse effects due to excessive blood levels of antibiotics or antiseptic solution.…”

“…The evidence that antibiotic solutions are effective for treating CVC-associated infection is much weaker. There have been five systematic reviews including our own, 73,75,80,112 but only one RCT 36 and two before-after studies. 78,79 Our systematic review found no clear evidence for the effectiveness of antibiotic lock treatment for CVC-associated bloodstream infection.…”

Bacteriophage K for reduction ofStaphylococcus aureusbiofilm on central venous catheter material

“…[1][2][3] Approximately 250000 cases of intravascular catheter-related bloodstream infections occur in the United States each year, resulting in a mortality of between 12-25% with an estimated cost of treatment per episode of approximately $25000. [3][4][5][6][7][8][9][10] The standard management of catheter-related infection involves decisions regarding removal of the catheter and the administration of appropriate antibiotics. Catheter removal and eventual replacement, raises important practical problems in these patients requiring parenteral nutrition, chemotherapy, and hemodialysis, among others.…”