Anti-Infective Locks For Treatment Of Central Line-Associated Bloodstream Infection

Central line-associated bloodstream infections (CLABSI) are associated with considerable morbidity, mortality and economic costs. In most cases, catheter removal is considered an essential component of managing CLABSI. However, in patients with poor access, catheter salvage may have to be attempted rather than removal and replacement of catheters. Anti-infective lock therapy (ALT) - instilling an antibiotic or antiseptic into the catheter lumen - is a novel way of treating CLABSI while attempting to salvage the catheter. However, data on the efficacy of ALT for catheter salvage is limited. In this systematic review, we critically review the evidence regarding the use of ALT for catheter salvage. We identified 8 studies including a total of 396 patients that compared ALT with systemic antibiotic therapy alone or an alternate method of catheter salvage (guidewire replacement). We found that the combination of systemic antibiotics and culture-guided lock therapy was superior to systemic antibiotics alone (OR: 0.20, 95% CI: 0.10-0.39), with 10% of locked patients requiring replacement compared to 33% of subjects without locks. There was a 20% relapse rate in the ALT group and a 30% relapse rate in the control group (OR: 0.43, 95% CI: 0.18-1.03). There was insufficient data on catheter exchange over a wire compared with ALT to permit conclusions. Our data support the use of ALT in conjunction with systemic antibiotics for catheter salvage. Large randomized controlled trials of ALT examining dose, dwell times and relapse rates stratified by infecting pathogen are needed.

Read the original article on PubMed Health here:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0035029/

Anti-infective lock solutions are used to prevent or treat central venous access device related bacteremias that result in the colonization of bacteria within the lumen of the device. The formation of a biofilm within the catheter lumen limits penetration of anti-infective solution.

Bacteria within the biofilm require 100 to 1000 times greater anti-infective concentration to achieve killing versus planktonic bacteria. Standard intravenous therapy does not reach high enough concentration to reduce bacterial burden within the biofilm of the catheter lumen. Therefore, pharmacologic concentrations of anti-invectives are used in anti-infective lock therapy either alone for prophylaxis or in combination with systemic therapy for treatment of catheter-related bacteremia.
Stability and compatibility of the anti-infective lock solution in combination with an anticoagulant must be considered when ordering an anti-infective lock solution.

http://www.uwhealth.org/files/uwhealth/docs/antimicrobial/Antibiotic_Lock_Solution_Guideline.pdf