Hemodialysis Catheter Locking Solutions and the Prevention of Catheter Dysfunction: A Meta-Analysis

Chapla, Kevin; Oza-Gajera, Bharvi P.; Yevzlin, Alexander S.; Astor, Brad C.; Chan, Micah R.

doi:10.5301/jva.5000312

Cited by 18 publications

(24 citation statements)

References 21 publications

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“…Although there is increasing recognition that antibiotic lock solutions can reduce the risk of infection, the standard lock solutions used clinically remain PBS alone and PBS containing heparin as an anticoagulant agent (26). Heparin is a sulfated polysaccharide analogous to carrageenan, a sulfated polysaccharide that is isolated from marine algae and is used as a growth substrate in microbiology plates to culture bacteria (10).…”

Section: Discussionmentioning

confidence: 99%

In Vitro and In Vivo Activity of a Novel Catheter Lock Solution against Bacterial and Fungal Biofilms

Chandra

Long

Isham

et al. 2018

Antimicrob Agents Chemother

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Central-line-associated bloodstream infections are increasingly recognized to be associated with intraluminal microbial biofilms, and effective measures for the prevention and treatment of bloodstream infections remain lacking. This report evaluates a new commercially developed antimicrobial catheter lock solution (ACL), containing trimethoprim (5 mg/ml), ethanol (25%), and calcium EDTA (Ca-EDTA) (3%), for activity against bacterial and fungal biofilms, using and (rabbit) catheter biofilm models. Biofilms were formed by bacterial (seven different species, including vancomycin-resistant [VRE]) or fungal () species on catheter materials. Biofilm formation was evaluated by quantitative culture (CFU) and scanning electron microscopy (SEM). Treatment with ACL inhibited the growth of adhesion-phase biofilms after 60 min (VRE) or 15 min (all others), while mature biofilms were completely inhibited after exposure for 2 or 4 h, compared to control. Similar results were observed for drug-resistant bacteria. Compared to the heparinized saline controls, ACL lock therapy significantly reduced the catheter bacterial (3.49 ± 0.75 versus 0.03 ± 0.06 log CFU/catheter; = 0.016) and fungal (2.48 ± 1.60 versus 0.55 ± 1.19 log CFU/catheter segment; = 0.013) burdens in the catheterized rabbit model. SEM also demonstrated eradication of bacterial and fungal biofilms on catheters exposed to ACL, while vigorous biofilms were observed on untreated control catheters. Our results demonstrated that ACL was efficacious against both adhesion-phase and mature biofilms formed by bacteria and fungi and.

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Section: Discussionmentioning

confidence: 99%

In Vitro and In Vivo Activity of a Novel Catheter Lock Solution against Bacterial and Fungal Biofilms

Chandra

Long

Isham

et al. 2018

Antimicrob Agents Chemother

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“…These include sodium citrate at various concentrations, acid citrate dextrose formula A (ACD‐A), antibiotic solutions +/− sodium citrate, NS, various concentrations of heparin, and rt‐PA. In recent systematic reviews, the only solution that showed potential benefit over heparin in preventing CVC malfunction was rt‐PA …”

Section: Discussionmentioning

confidence: 99%

Tissue plasminogen activator vs heparin for locking central venous catheters between apheresis procedures

Mathur

Mott

Collins

et al. 2019

J of Clinical Apheresis

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Background Central venous catheters (CVCs) for apheresis procedures require regular locking/flushes to maintain adequate flow rates. Literature comparing locking solutions for apheresis, where the time interval between procedures can be longer than for hemodialysis (many days to weeks), is lacking. In this study, catheter malfunction rates using recombinant tissue plasminogen activator (rt‐PA) vs heparin for locking CVC between apheresis procedures were compared. Study Design and Methods A retrospective review of 93 extracorporeal photopheresis procedures in 10 patients was performed at our institution. About 1000 U/mL heparin or 2 mg rt‐PA was used as the locking solution. Heparin locks were changed at least once per week and rt‐PA locks could be left in place for up to 4 weeks. Following these locks, inadequate blood flow noted on accessing CVC and/or during the procedure was scored on as: no issues, some issues, or significant issues. Binary logistic regression was used to evaluate for potential statistical difference in outcomes. Cost analysis was also performed. Results No statistically significant difference was noted in outcomes between heparin and rt‐PA lock (P value = 0.15). Total cost of heparin lock administration ($91‐$362.50) was found to be more than rt‐PA lock ($76) when more than one flush was needed between procedures. Conclusions For apheresis use, rt‐PA and heparin CVC locks seem to have similar outcomes in preventing CVC malfunction. The convenience of not needing any flushes between procedures and overall cost of administering fewer locks favors rt‐PA use when the interval between procedures is >7 days.

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“…Although there is increasing recognition that antibiotic lock solutions can reduce the risk of infection, the standard lock solutions used clinically remain PBS alone or containing Heparin as an anti-coagulant agent Chapla et al . (29). Heparin is a sulfated polysaccharide analogous to carrageenan, also a sulfated polysaccharide that is isolated from marine algae and used as a growth substrate in microbiology plates to culture bacteria (10).…”

Section: Discussionmentioning

confidence: 99%

In VitroandIn Vivoactivity of a novel catheter lock solution against bacterial and fungal biofilms

Chandra

Long

Isham

et al. 2018

Preprint

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Central line associated bloodstream infections (CLABSIs) are increasingly recognized to be associated with intralumenal microbial biofilms, and effective measures for the prevention and treatment of BSI remain lacking. This report evaluates a new commercially developed antimicrobial catheter lock solution (ACL) containing trimethoprim (5 mg/ml) and ethanol (25%) and CA-EDTA 3% for activity against bacterial and fungal biofilms using in vitro and in vivo (rabbit) catheter biofilm models. Biofilms were formed with bacterial (seven different species including vancomycin-resistant enterococcus, VRE) or fungal (C. albicans) species on catheter materials. Biofilm formation was evaluated by quantitative culture (colony forming units, CFUs) and scanning electron microscopy (SEM). Treatment with ACL inhibited growth of adhesion phase biofilms in vitro after 60 min (VRE) or 15 min (all others), while mature biofilms were eradicated after exposure for 2 or 4 h, compared to control. Similar results were observed for drug-resistant bacteria. In the catheterized rabbit model, when compared against heparinized saline control, ACL lock therapy significantly reduced the catheter bacterial (3.49 ± 0.75 vs. 0.03 ± 0.06 log CFU/catheter, respectively; P = 0.001) and fungal burden (2.48 ± 1.60 vs. 0.55 ± 1.19 log CFU/catheter segment, respectively; P = 0.012). SEM also demonstrated eradication of bacterial and fungal biofilms in vivo on catheters exposed to ACL, while vigorous biofilms were observed on untreated control catheters. Our results demonstrate that ACL was efficacious against both adhesion phase and mature biofilms formed by bacteria and fungi in vitro as well as in vivo.

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Hemodialysis Catheter Locking Solutions and the Prevention of Catheter Dysfunction: A Meta-Analysis

Cited by 18 publications

References 21 publications

In Vitro and In Vivo Activity of a Novel Catheter Lock Solution against Bacterial and Fungal Biofilms

In Vitro and In Vivo Activity of a Novel Catheter Lock Solution against Bacterial and Fungal Biofilms

Tissue plasminogen activator vs heparin for locking central venous catheters between apheresis procedures

In VitroandIn Vivoactivity of a novel catheter lock solution against bacterial and fungal biofilms

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