Antimicrobial locks: putting the lock on catheter infections

Infectious complications resulting from catheter use in the hemodialysis population remain as the significant cause of morbidity and mortality in this patient population. Because conservation of vascular access sites remains a therapeutic mainstay for chronic hemodialysis patients, clinical investigators have evaluated the safety and efficacy of catheter preservation with antimicrobial lock solutions instilled into the lumens of catheters to treat and prevent infectious complications. The recommended treatment of catheter-related bacteremia includes administration of systemic antibiotics with catheter removal. To date, 4 studies in the hemodialysis population have evaluated the use of systemic antibiotics with an antimicrobial lock solution for treatment of catheter-related bacteremias to amplify the success of catheter salvage. The use of antimicrobial lock solutions for the treatment of catheter-related bacteremia has resulted in successful catheter salvage in approximately 69% of patients, with the remainder requiring catheter removal following a lack of clinical improvement after 48 hours. The antimicrobial lock has also been studied as a prophylactic measure to prevent catheter-related bacteremia. Six studies in the hemodialysis population have evaluated the use of an antimicrobial lock for the prevention of catheter-related bacteremia with an overall 64%-100% reduction in the frequency of catheter-related bacteremia. Although the use of antimicrobial lock for prophylaxis has demonstrated efficacy in clinical trials, its long-term consequences, including potential impact on antimicrobial resistance, are unknown. The objectives of this review are to evaluate the current body of evidence espousing the utilization of an antimicrobial lock solution in tunneled cuffed and uncuffed catheters that are utilized during chronic intermittent hemodialysis.