Systematic Review Of Preventing Haemodialysis Catheter-related Infection With An Antimicrobial Lock Solution

Objective:Stable and reliable vascular access is hemodialysis patients with hemodialysis as a basic guarantee.Deep vein catheters have been used widely in hemodialysis.Catheter-related infections(CRI)is one of major complications for long term catheter using,and it is a major cause of morbidity and mortality in hemodialysis patients.A lot of studies assessed the efficacy of catheter-restricted filling with antibiotics and heparin to prevent CRI,but,there are not large scale Randomized controlled trials(RCTs)or systematic reviews to assess the efficacy and safety of using antimicrobial lock solutions(ALS),which make it lack forceful support of evidence-based medicine(EBM).The objective of this study:to assess the efficacy and safety of using ALS to prevent CRI and provide EBM theoretical basis for this technology.Methods:We searched the Cochrane Library,Medline Database,Embase Database, CBMdisc and CEBM/CCD and 10 kinds of Chinese Medical journals until December,2007.Randomized controlled trials compared using ALS with heparin solutions to prevent CRI.Data were extracted independently by two reviewers.The methodological quality of trials was assessed by the Jadad-Scored.Statistical analysis were performed with RevMan4.2.Results:Search-related literature to a total of 213,149 magazines in English,Chinese magazine 64.Documents retrieved 157 antibiotics and closure of heparin mixture of dialysis catheter-related infections,in line with the standards included 10 randomized controlled trials literature,including a total of 1,044 cases of patients Meta-analysis showed that:(1)the application of appropriate mixture of antibiotics and heparin, including gentamicin,cefazolin,cefotaxime,ceftazidime,Norvancomycin and other heparin mix In each of hemodialysis after the closure,the catheter can indeed reduce infection rates and reduce catheter 1000,the incidence of infection,and improve the survival rate of infection without catheter,lower export catheter infection rates and reduce catheter G+ bacteria,G-bacteria Infection rate.(2)the use of antibiotics and heparin mixture of the closure catheter did not increase the incidence of thrombosis(3)the use of antibiotics and heparin mixture of the closure did not increase liver and kidney damage,skin rashes,drug resistance,such as the incidence of adverse events.Conclusion:The use of antibiotics and heparin mixture of the closure is effective,to reduce catheter-related infection rates,improve the survival rate of infection without catheter;mixture heparin of Antibiotics and the closure is safe,not to increase catheter thrombosis Rates,not to increase long-term use of antibiotics caused by the incidence of adverse events.