title: Antimicrobial lock solutions as a method to prevent central line-associated bloodstream infections: a meta-analysis of randomized controlled trials.
abstract: BACKGROUND
  Antimicrobial lock solutions may be an effective strategy to prevent catheter-associated infections. However, there remains concern about their efficacy and safety.
  
  
  METHODS
  To investigate the efficacy of antimicrobial lock therapy to prevent central line-associated bloodstream infections (CLABSIs), we performed a systematic search of PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov, from the earliest date up to 31 December 2013. Studies were eligible if they were randomized controlled trials comparing antimicrobial lock solutions to heparin and if they provided an appropriate definition of infection.
  
  
  RESULTS
  The 23 included studies reported data on 2896 patients, who were predominantly adult patients undergoing hemodialysis (16/23 studies), but also adult and pediatric oncology patients, critically ill neonates, and patients receiving total parenteral nutrition. The use of antimicrobial lock solutions led to a 69% reduction in CLABSI rate (relative risk [RR], 0.31; 95% confidence interval [CI], .24-.40) and a 32% reduction in the rate of exit site infections (RR, 0.68; 95% CI, .49-.95) compared with heparin, without significantly affecting catheter failure due to noninfectious complications (RR, 0.83; 95% CI, .65-1.06). All-cause mortality was not different between the groups (RR, 0.84; 95% CI .64-1.12). Neither the type of antimicrobial solution nor the population studied, affected the relative reduction in CLABSIs, which also remained significant among studies reporting baseline infection rates of <1.15 per 1000 catheter-days, and studies providing data for catheter-related bloodstream infections. Publication and selective reporting bias are a concern in our study and should be acknowledged.
  
  
  CONCLUSIONS
  Antimicrobial lock solutions are effective in reducing risk of CLABSI, and this effect appears to be additive to traditional prevention measures.
authors.affiliation: Infectious Diseases Division, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Ioannis M
authors.initials: IM
authors.lastname: Zacharioudakis
authors.affiliation: Infectious Diseases Division, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Fainareti N
authors.initials: FN
authors.lastname: Zervou
authors.affiliation: Infectious Diseases Division, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Marios
authors.initials: M
authors.lastname: Arvanitis
authors.affiliation: Infectious Diseases Division, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Panayiotis D
authors.initials: PD
authors.lastname: Ziakas
authors.affiliation: Infectious Diseases Division, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Leonard A
authors.initials: LA
authors.lastname: Mermel
authors.affiliation: Infectious Diseases Division, Rhode Island Hospital Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D000890:Anti-Infective Agents / Q000627:therapeutic use*; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects; D006801:Humans; D016032:Randomized Controlled Trials as Topic
chemical_list: D000890:Anti-Infective Agents
keywords: CLABSI; CRBSI; central venous catheters; infection; lock