The CLOCK trial, a double‐blinded randomized controlled trial: Trisodium citrate 30% and minocycline 3 mg/mL plus EDTA 30 mg/mL are effective and safe for catheter patency maintenance among CKD 5D patients on hemodialysis

Luiz, Marcus V. S. João; Scavone, Cristóforo; Tzanno, Carmen

doi:10.1111/hdi.12492

Cited by 13 publications

(11 citation statements)

References 17 publications

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“…Based on the above studies and others, IDSA guidelines [ 15 ] that were published in 2009 recommended catheter removal for staphylococcal bacteremia; however, targeting higher vancomycin levels as the standard of practice, availability of diverse antibiotic lock solutions [ 19 , 20 , 21 , 22 ], and dire need of hemodialysis patients to minimize the frequency of catheter insertions should instigate clinical trials to re-examine the applicability of antibiotic lock solutions in maintaining the catheter in place and consequently conserving the options for dialysis access.…”

Section: Discussionmentioning

confidence: 99%

Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

Nekidy

Soong

Kadri

et al. 2018

Case Rep Nephrol Dial

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Catheter-related blood stream infections comprise a major concern in hemodialysis patients, leading to increased mortality, morbidity, and cost of treatment. Prompt appropriate systemic antibiotics treatment, which includes administration of appropriate systemic antibiotics and, frequently, catheter removal and replacement, is warranted. However, in hemodialysis patients, repeated catheter insertions may cause central vein stenosis and thrombosis which limits the future availability of hemodialysis access. Lock solutions containing antibiotics and anticoagulants, instilled directly into the catheter lumen after each dialysis, have been successfully utilized for catheter salvage but higher rates of recurrence and complications were observed in infections resulting from staphylococcal species. We report several cases of catheter salvage using antibiotic lock solution in staphylococcal bacteremia with the purpose of stimulating the interest in randomized clinical trials. Evaluating the risk and benefits of catheter salvage in this patient subset in light of optimized systemic antibiotic dosing, improved lock solution use, and multidisciplinary involvement, balanced with the critical need to prevent unnecessary vascular trauma, is of great importance.

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Section: Discussionmentioning

confidence: 99%

Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

Nekidy

Soong

Kadri

et al. 2018

Case Rep Nephrol Dial

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“…Subsequently, João Luiz et al 34 led a double-blinded RCT comparing heparin, trisodium citrate 30%, and M-EDTA locks. All included 68 patients on hemodialysis, had less hydraulic resistance while on the M-EDTA locks (0.9 events per 1,000 catheter days), than the trisodium citrate (2.0 events per 1,000 catheter days), or with the heparin locks (9.2 events per 1,000 catheter days; P = .001).…”

Section: Edta-based Catheter Lock Solutionsmentioning

confidence: 99%

“…44 Catheter lock solutions comprising citrate have been widely studied with concentrations up to 46%. 34,[45][46][47][48][49][50] Antibiotics that have been tested in combination with citrate as catheter lock solutions include gentamicin, ciprofloxacin, tobramycin, vancomycin, and telavancin. 36,[51][52][53][54][55] Citrate has also been combined with other nonantibiotic antimicrobial agents in catheter lock solutions including ethanol, ethanol and glyceryl trinitrate, taurolidine, and methylene blue plus methyl and propyl parabens.…”

Section: Citrate-based Catheter Lock Solutionsmentioning

confidence: 99%

“…The use of high citrate concentrations (up to 30%-46.7%) have been used with promising results. 34,[45][46][47][48][49][50] A multicenter, double-blind, RCT comparing high citrate concentration (30%) to heparin (5,000 IU/mL) in the Netherlands and Belgium showed that citrate may reduce the risk of catheter-related infections by 75%, may prevent premature CVC removal, and may decrease the risk of heparin-related bleeding complications. 50 Another double-blinded RCT in Brazil comparing heparin 1,000 IU/mL to trisodium citrate 30% or minocycline 3 mg/mL in EDTA 30 mg/mL showed that citrate and EDTA were safe and effective for catheter patency compared to heparin.…”

Section: Citrate-based Catheter Lock Solutionsmentioning

confidence: 99%

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Advances in the prevention and management of central-line–associated bloodstream infections: The role of chelator-based catheter locks

Chaftari

Viola

Rosenblatt

et al. 2019

Infect. Control Hosp. Epidemiol.

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The proper functioning of central lines is imperative for the management of patients with cancer or on hemodialysis. However, these lifelines can become infected and can malfunction.Chelators such as citrate and EDTA have been widely studied alone or in combination with other antimicrobial agents in catheter lock solutions to prevent catheter-related bloodstream infections and to maintain catheter patency. Given their anticoagulation, antiplatelet aggregation, antibiofilm, antimicrobial activity, safety profile, as well as their low cost, chelators have long been considered alternatives to heparin and a vital component of catheter lock solutions. In this review, we present a detailed summary of the properties of chelators and in vitro and in vivo studies of chelator-containing lock solutions.

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“…The use of a combination of CAI prophylaxis measures in a standardized protocol has been shown to reduce rates of CAB . However, while multiple trials and meta‐analyses have demonstrated benefit for individual products or procedures the optimal combination of prophylactic measures remains unknown. In this context, significant clinical variability in catheter management practices across Australia and New Zealand dialysis units might be expected.…”

mentioning

confidence: 99%

Dialysis catheter management practices in Australia and New Zealand

et al. 2019

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Aim: Dialysis catheter-associated infections (CAI) are a serious and costly burden on patients and the health-care system. Many approaches to minimizing catheter use and infection prophylaxis are available and the practice patterns in Australia and New Zealand are not known. We aimed to describe dialysis catheter management practices in dialysis units in Australia and New Zealand.Methods: Online survey comprising 52 questions, completed by representatives from dialysis units from both countries.Results: Of 64 contacted units, 48 (75%) responded (Australia 43, New Zealand 5), representing 79% of the dialysis population in both countries. Nephrologists (including trainees) inserted non-tunnelled catheters at 60% and tunnelled catheters at 31% of units. Prophylactic antibiotics were given with catheter insertion at 21% of units. Heparin was the most common locking solution for both non-tunnelled (77%) and tunnelled catheters (69%), with antimicrobial locks being predominant only in New Zealand (80%). Eight different combinations of exit site dressing were in use, with an antibiotic patch being most common (35%). All units in New Zealand and 84% of those in Australia undertook CAI surveillance. However, only 51% of those units were able to provide a figure for their most recent rate of catheter-associated bacteraemia per 1000 catheter days.Conclusion: There is wide variation in current dialysis catheter management practice and CAI surveillance is suboptimal. Increased attention to the scope and quality of CAI surveillance is warranted and further evidence to guide infection prevention is required.

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The CLOCK trial, a double‐blinded randomized controlled trial: Trisodium citrate 30% and minocycline 3 mg/mL plus EDTA 30 mg/mL are effective and safe for catheter patency maintenance among CKD 5D patients on hemodialysis

Abstract: The CLOCK Trial suggests TSC and M-EDTA may preserve catheter patency better than H. TSC may be a better option due the lack of association with long-term antimicrobial resistance.

Cited by 13 publications

References 17 publications

Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

Salvage of Hemodialysis Catheter in Staphylococcal Bacteremia: Case Series, Revisiting the Literature, and the Role of the Pharmacist

Advances in the prevention and management of central-line–associated bloodstream infections: The role of chelator-based catheter locks

Dialysis catheter management practices in Australia and New Zealand

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