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| |  Antimicrobial Lock Solutions Reduce Catheter-Related Infections in Haemodialysis Patients: Presented at ASN By Bryan DeBusk, PhD SAN FRANCISCO, CA -- November 5, 2007 -- Patients receiving haemodialysis through catheters utilising an antimicrobial lock solution have only about one third the risk of infection compared with dialysis with catheters lacking the solutions, according to a meta-analysis of prospective, randomised, controlled trials. Michel Jadoul, MD, Head of the Department of Nephrology, Cliniques Universitaires St.-Luc, Brussels, Belgium, reported the findings here at Renal Week 2007, the American Society of Nephrology (ASN) Annual Meeting. The analysis of eight studies reported between January 1990 and March 2007 examined the incidence of catheter-related bacteraemia (CRB) in 925 patients with 992 catheters and 129,976 catheter-days. Two hundred twenty-six incidences of CRB were observed over 64,280 catheter-days in patients using a standard heparin lock compared with 77 CRB over 65,696 catheter-days in patients using one of several antimicrobial lock solutions (Relative Risk.353; 95% confidence interval [CI] 0.112-0.411). Other risk factors -- including presence of diabetes, duration of follow-up, albumin and ferritin levels, proportion of tunnelled catheters, and use of intranasal mupirocin -- did not appear to affect the likelihood of CRB. Citrate did not confer a benefit over gentamicin or other traditional antibiotics, but gentamicin was better at preventing CRB than other traditional antibiotics (P =.002). Dr. Jadoul noted that not all haemodialysis centres will see a decrease in CRB with the introduction of antibiotic lock solutions. "Even though the reduction of the risk is impressive, to be honest, it's not sure that everybody should use this. The lower the incidence [of CRB] in your unit, the lower the chance to have a benefit," he said. Expressing concern about the long-term potential for antibiotic resistance with the use of antimicrobial lock solutions, Dr. Jadoul noted that the use of citrate eliminates potential for resistance and appears to be safe. However, he indicated that long-term observations would be necessary to determine the continued safety and efficacy of all antimicrobial lock solutions.
[Presentation Title: Preventing Hemodialysis Catheter-Related Bacteraemia With an Antimicrobial Lock Solution: A Meta-Analysis of Prospective Randomized Trials. Abstract SU-PO668]
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