title: The role of chelators in preventing biofilm formation and catheter-related bloodstream infections.
abstract: OBJECTIVE
  As metallic cations are essential to microbial adherence, biofilm formation, and bacterial growth, efforts have been directed toward utilizing metal-binding chelators that have the capability of inhibiting bacterial growth by disrupting surface adherence and preventing biofilm production. This review focuses on recent advances in the role of chelators in biofilm disruption and prevention of catheter-related bloodstream infections.
  
  
  RESULTS
  The most important factor in the pathogenesis of catheter-related bloodstream infections is the intraluminal colonization of the central venous catheters through the formation of bacterial biofilm matrix in which microbial organisms embed themselves and eventually become a source of catheter-related bloodstream infections. It has been demonstrated that high-affinity metal-binding chelators including ethylenediamine-tetraacetic acid and citrate have the capacity of inhibiting microbial growth by disrupting surface adherence and preventing biofilm production. Furthermore, ethylenediamine-tetraacetic acid and citrate have been clinically shown to be highly effective and outperform heparin in the prevention and treatment of catheter-related bloodstream infections when used as a component of antimicrobial catheter lock solutions.
  
  
  CONCLUSIONS
  It is suggested that the addition of chelators such as ethylenediamine-tetraacetic acid and citrate to antimicrobial lock solutions provides an innovative and superior alternative to heparin lock solution in the prevention and treatment of catheter-related bloodstream infections.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, Texas 77030, USA. iraad@mdanderson.org
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
authors.forename: Xiang
authors.initials: X
authors.lastname: Fang
authors.forename: Xavier M
authors.initials: XM
authors.lastname: Keutgen
authors.forename: Ying
authors.initials: Y
authors.lastname: Jiang
authors.forename: Robert
authors.initials: R
authors.lastname: Sherertz
authors.forename: Ray
authors.initials: R
authors.lastname: Hachem
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000517:prevention & control*; D001422:Bacterial Adhesion / Q000187:drug effects; D018441:Biofilms / Q000187:drug effects*; D002404:Catheterization; D002614:Chelating Agents / Q000494:pharmacology*; D019343:Citric Acid / Q000494:pharmacology; D004492:Edetic Acid / Q000494:pharmacology; D004864:Equipment and Supplies / Q000382:microbiology*; D006801:Humans
chemical_list: D000900:Anti-Bacterial Agents; D002614:Chelating Agents; D019343:Citric Acid; D004492:Edetic Acid