Comparative efficacy of various antimicrobial lock solutions for preventing catheter-related bloodstream infections: A network meta-analysis of 9099 patients from 52 randomized controlled trials

Abstract

Objectives: It remains uncertain which catheter lock solution (CLS) to prevent catheter-related bloodstream infections (CRBSI) works best and is safest for patients. This study was performed to compare the efficacy of different CLSs for the prevention of CRBSI and ranked these CLSs for practical consideration. Methods: The PubMed, Web of Science, Embase, and MEDLINE databases, earlier relevant meta-analyses, and the reference lists of included studies were searched. The primary outcome was CRBSI; secondary outcomes were catheter-related thrombosis and exit-site infections. A network meta-analysis was performed to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Results: A total of 52 randomized controlled trials involving 9099 patients and evaluating 13 CLSs (single and combinations) were included. With regard to the quality of the evidence, the risk of bias was typically low or unclear (45 out of 52 trials, 86.5%). In the network meta-analysis, saline (OR 8.44, 95% CI 2.19–32.46), gentamicin + citrate (OR 2.92, 95% CI 1.32–6.42), ethanol (OR 5.33, 95% CI 1.22–23.32), and cloxacillin + heparin (OR 2.07, 95% CI 1.19–5.49) were associated with a greater effect on CRBSI than heparin. Conclusions: This network meta-analysis showed that minocycline–ethylenediaminetetraacetic acid (EDTA) seemed to be the most effective for the prevention of CRBSI and exit-site infection, and cefotaxime + heparin seemed to be the most effective for catheter-related thrombosis. Keywords: Catheter-related bloodstream infections, Catheter lock solutions, Network meta-analysis