Table 7 Trials of haemodialysis catheter-locking solutions or catheter materials for CRBSI prevention
From: Catheter-related bloodstream infection in end-stage kidney disease: a Canadian narrative review
Interventiona | Population size and characteristics | Significant infection reduction? | Limitations and attributes | Ref |
|---|---|---|---|---|
Cloxacillin vs. heparin | 100 (uncuffed temporary lines) | Yes (0.5 vs. 7.8/1000 catheter-days) | Small sample, short median catheter life (60Â days) | [61] |
Bismuth-coated catheters | 77 (uncuffed catheters) | No (significantly reduced catheter colonization in CFU/mL, 63 vs. 3.5, p < 0.001) | Majority of catheters removed as HD no longer required | [62] |
Cefotaxime vs. heparin | 113, >65 yrs. (tunnelled cuffed catheters) | Yes (at 1 year, 68.7 vs. 31.3 %, p < 0.001) | Small sample, high baseline proportion infection | [63] |
Cefotaxime vs. heparin | 109, diabetic (tunnelled cuffed catheters) | Yes (at 1 year, 3.7 vs. 1.6/1000 catheter-days) | Small sample, majority of reduction attributable to Gram negative infections | [64] |
46.7 % citrate vs. heparinb | 210 (tunnelled cuffed catheters) | Yes (0.81 vs. 2.13/1000 catheter-days; p < 0.0001) Thrombosis reduced (RR 0.87, 95 %CI 0.83–0.93, p < 0.0001) | Thrombosis measured indirectly (alteplase use), no benefit in diabetics or in those with prevalent catheters | [65] |
rtPA (1 of 3 sessions/week) vs. heparin (3 times/week) | 225 (new HD lines) | Yes (0.40 vs. 1.37/1000 catheter-days; p = 0.02) Line failure reduced (20.0 vs. 34.8 %, p = 0.02) | RCT, patients and assessors blinded, high cost of rtPA | [66] |
Taurolidine-citrate-heparin vs. heparin | 565 (tunnelled cuffed catheters) | Yes (0.69 vs. 1.59/1000 catheter-days, p < 0.004) | Single centre, 2-year prospective observational study (not randomized) | [67] |