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Catheter lock solutions for reducing catheter-related bloodstream infections in paediatric patients: a network
1Department of Nosocomial Infection Prevention and Control, Beijing Friendship Hospital, Capital Medical University, Beijing, China.
Insights
Taurolidine plus heparin is the most effective catheter lock solution for preventing catheter-related bloodstream infections in children. Further research is needed to confirm the effectiveness of various catheter lock solutions in pediatric patients.
Area of Science:
- Medical Research
- Infectious Disease Prevention
- Pediatric Critical Care
Background:
- Catheter-related bloodstream infections (CRBSI) are a significant risk for pediatric patients with central venous catheters (CVCs).
- Various catheter lock solutions (CLSs) are used to mitigate CRBSI risk, but optimal choices remain unclear.
Purpose of the Study:
- To compare the efficacy of different CLSs in preventing CRBSI among pediatric patients.
- To identify the most effective CLS for CRBSI prevention in this population.
Main Methods:
- A systematic literature search was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library) up to May 2021.
- Randomized controlled trials (RCTs) evaluating CLSs for CRBSI prevention in pediatric patients were included.
- A random-effects network meta-analysis was performed to calculate risk ratios (RR) and 95% confidence intervals (CI).
Main Results:
- Thirteen studies involving 1335 pediatric patients were analyzed.
- Taurolidine plus heparin demonstrated significant effectiveness in preventing CRBSI compared to heparin alone (RR: 0.21, 95% CI: 0.09-0.51).
- Other CLSs, including vancomycin, ethanol, fusidic acid, and amikacin, showed no significant difference in CRBSI prevention compared to heparin.
Conclusions:
- Taurolidine lock solution, particularly when combined with heparin, appears to be the most effective CLS for preventing CRBSI in pediatric patients.
- High-quality, well-designed RCTs are necessary to provide more definitive evidence on the comparative effectiveness of different CLSs in pediatric populations.
Background:
Different catheter lock solutions (CLSs) are used to reduce catheter-related bloodstream infection (CRBSI) for paediatric patients with central venous catheters (CVCs), but the most effective CLS is unknown.
Aim:
To compare the effectiveness of different CLSs for the prevention of CRBSI in paediatric patients.
Methods:
Potential studies were searched and selected through the PubMed, Embase, Web of Science and Cochrane Library up to May 2021. Randomized controlled trials that assessed the effects of CLSs for preventing CRBSI in paediatric patients were included. We performed a random-effects network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI).
Findings:
Thirteen studies comprising 1335 patients were included in the network meta-analysis. Taurolidine + heparin was effective in the prevention of CRBSI compared with heparin in paediatric patients (RR: 0.21, 95% CI: 0.09-0.51). No significant difference was found between the other CLSs (such as vancomycin, ethanol, fusidic acid, amikacin, and amikacin and vancomycin) and heparin or between different intervention lock solutions for CRBSI prevention. Based on the surface under the cumulative ranking curve, taurolidine + heparin (85.3%) appeared to be the most effective solution for effectiveness on CRBSI prevention, followed by fusidic acid + heparin (77.0%) and amikacin + heparin (65.7%). There was no statistical global inconsistency among the included studies after design by treatment test (χ2 = 2.22, P=0.137).
Conclusion:
The study showed that taurolidine lock solution seemed to be the most effective for the prevention of CRBSI in paediatric patients. Well-designed randomized trials in paediatric patients are needed to provide more reliable evidence in the effectiveness of different CLSs.
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