Antimicrobial Lock Therapy in Clinical Practice: A Scoping Review

Area of Science:

• Infectious Diseases
• Pharmacology
• Clinical Medicine

Background:

• Antimicrobial lock therapy (ALT) is used to prevent microbial colonization and treat catheter-related bloodstream infections (CRBSIs).
• Assessing ALT involves identifying patient suitability, clinical contexts, usage trends, administration methods, and literature availability for systematic reviews.
• A scoping review following PRISMA-ScR guidelines was conducted to map the existing evidence on ALT.

Purpose of the Study:

• To conduct a comprehensive scoping review of antimicrobial lock therapy (ALT) for central vein catheters.
• To identify key considerations in ALT assessment, including patient selection, clinical applications, and administration practices.
• To evaluate the existing literature to determine the feasibility of future systematic reviews and meta-analyses.

Main Methods:

• A five-stage methodological framework was employed.
• A systematic search identified 1024 studies.
• 336 studies were included in the final analysis.

Main Results:

• Ethanol and taurolidine are widely used for CRBSI prevention.
• ALT is concurrently used with systemic antimicrobials for CRBSI treatment, often avoiding catheter removal.
• ALT demonstrates improved clinical outcomes, including enhanced post-infection survival and catheter retention rates.

Conclusions:

• Antimicrobial lock therapy (ALT) is a valuable strategy for managing central venous catheter-related bloodstream infections (CRBSIs).
• The findings support the use of ethanol and taurolidine and the combination of ALT with systemic antimicrobials.
• Future research, including an umbrella review and network meta-analysis, is recommended to provide clearer clinical practice guidelines.