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Cochrane Database of Systematic Reviews

Soluciones de sellado con antimicrobianos para la prevención de las infecciones relacionadas con el catéter en la hemodiálisis

Information

DOI:
https://doi.org/10.1002/14651858.CD010597.pub2Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 03 April 2018see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Kidney and Transplant Group

Copyright:
  1. Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Maria C Arechabala

    Correspondence to: Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile

    [email protected]

  • Maria I Catoni

    Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile

  • Juan Carlos Claro

    Departamento de Medicina Interna, Programa de Salud Basada en Evidencia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

  • Noelia P Rojas

    Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile

  • Miriam E Rubio

    Escuela de Enfermería, Pontificia Universidad Católica de Chile, Santiago, Chile

  • Mario A Calvo

    Escuela de Medicina, Universidad Austral de Chile, Valdivia, Chile

  • Luz M Letelier

    Departamento de Medicina Interna, Programa de Salud Basada en Evidencia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Contributions of authors

  1. Draft the protocol: MCA, MIC, JCC, LML, MC

  2. Develop a search strategy: MCA, MIC

  3. Search for studies: MCA, MIC

  4. Obtain copies of studies: MCA

  5. Study selection: MCA, MIC

  6. Extract data from studies: NR, MR

  7. Enter data into RevMan: MCA, MIC, JCC

  8. Carry out the analysis: JCC, MCA, MIC

  9. Interpret the analysis: MCA, MIC, JCC, LML

  10. Draft the final review: MCA, MIC, JCC, LML

  11. Disagreement resolution: MCA, MIC, JCC, LML

  12. Update the review: MCA, MIC, JCC, LML

Sources of support

Internal sources

  • New Source of support, Other.

External sources

  • FONIS: Fondo Nacional de Investigación y Desarrollo en Salud, Chile.

Declarations of interest

All authors were recipients of a clinical research grant from: Fondo Nacional de Investigación y Desarrollo en Salud (FONIS) from the Chilean government.

Acknowledgements

We wish to thank the referees for their feedback and comments during the preparation of this review.

Version history

Published

Title

Stage

Authors

Version

2018 Apr 03

Antimicrobial lock solutions for preventing catheter‐related infections in haemodialysis

Review

Maria C Arechabala, Maria I Catoni, Juan Carlos Claro, Noelia P Rojas, Miriam E Rubio, Mario A Calvo, Luz M Letelier

https://doi.org/10.1002/14651858.CD010597.pub2

2013 Jul 02

Antimicrobial lock solutions for preventing catheter‐related infections in haemodialysis

Protocol

Maria C Arechabala, Maria I Catoni, Juan Carlos Claro, Noelia P Rojas, Miriam E Rubio, Mario A Calvo, Luz M Letelier

https://doi.org/10.1002/14651858.CD010597

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study selection flow diagram
Figures and Tables -
Figure 1

Study selection flow diagram

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figures and Tables -
Figure 2

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 3

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Funnel plot of comparison: 1 Antimicrobial (Antibiotic plus non‐antibiotic) solutions versus control, outcome: 1.1 CVC‐related infection (per 1000 catheter‐days).
Figures and Tables -
Figure 4

Funnel plot of comparison: 1 Antimicrobial (Antibiotic plus non‐antibiotic) solutions versus control, outcome: 1.1 CVC‐related infection (per 1000 catheter‐days).

Funnel plot of comparison: 1 Antimicrobial (antibiotic plus non‐antibiotic) lock solutions versus control, outcome: 1.3 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Figure 5

Funnel plot of comparison: 1 Antimicrobial (antibiotic plus non‐antibiotic) lock solutions versus control, outcome: 1.3 Thrombosis (per 1000 catheter‐days).

Funnel plot of comparison: 3 Antibiotic lock solutions versus control, outcome: 3.1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Figure 6

Funnel plot of comparison: 3 Antibiotic lock solutions versus control, outcome: 3.1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 1.1

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 2 Catheter‐related infection (per 1000 dialysis sessions).
Figures and Tables -
Analysis 1.2

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 2 Catheter‐related infection (per 1000 dialysis sessions).

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 3 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 1.3

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 3 Thrombosis (per 1000 catheter‐days).

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 4 Colonisation.
Figures and Tables -
Analysis 1.4

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 4 Colonisation.

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 5 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters.
Figures and Tables -
Analysis 1.5

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 5 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters.

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters.
Figures and Tables -
Analysis 1.6

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters.

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 7 Subgroup analysis: thrombosis (per 1000 catheter‐days) in tunnelled catheters.
Figures and Tables -
Analysis 1.7

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 7 Subgroup analysis: thrombosis (per 1000 catheter‐days) in tunnelled catheters.

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 8 Subgroup analysis: thrombosis (per 1000 catheter‐days) in non‐tunnelled catheters.
Figures and Tables -
Analysis 1.8

Comparison 1 All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control, Outcome 8 Subgroup analysis: thrombosis (per 1000 catheter‐days) in non‐tunnelled catheters.

Comparison 2 Sensitivity analysis: all antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 2.1

Comparison 2 Sensitivity analysis: all antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 2 Sensitivity analysis: all antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 2.2

Comparison 2 Sensitivity analysis: all antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).

Comparison 3 Antibiotic lock solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 3.1

Comparison 3 Antibiotic lock solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 3 Antibiotic lock solutions versus control, Outcome 2 Catheter‐related infection (per 1000 dialysis sessions).
Figures and Tables -
Analysis 3.2

Comparison 3 Antibiotic lock solutions versus control, Outcome 2 Catheter‐related infection (per 1000 dialysis sessions).

Comparison 3 Antibiotic lock solutions versus control, Outcome 3 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 3.3

Comparison 3 Antibiotic lock solutions versus control, Outcome 3 Thrombosis (per 1000 catheter‐days).

Comparison 3 Antibiotic lock solutions versus control, Outcome 4 Colonisation.
Figures and Tables -
Analysis 3.4

Comparison 3 Antibiotic lock solutions versus control, Outcome 4 Colonisation.

Comparison 3 Antibiotic lock solutions versus control, Outcome 5 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters.
Figures and Tables -
Analysis 3.5

Comparison 3 Antibiotic lock solutions versus control, Outcome 5 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters.

Comparison 3 Antibiotic lock solutions versus control, Outcome 6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters.
Figures and Tables -
Analysis 3.6

Comparison 3 Antibiotic lock solutions versus control, Outcome 6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters.

Comparison 3 Antibiotic lock solutions versus control, Outcome 7 Subgroup analysis: thrombosis per 1000 catheter‐days in tunnelled catheters.
Figures and Tables -
Analysis 3.7

Comparison 3 Antibiotic lock solutions versus control, Outcome 7 Subgroup analysis: thrombosis per 1000 catheter‐days in tunnelled catheters.

Comparison 4 Sensitivity analysis: antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 4.1

Comparison 4 Sensitivity analysis: antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 4 Sensitivity analysis: antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 4.2

Comparison 4 Sensitivity analysis: antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 5.1

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 2 Catheter‐related infection (per 1000 dialysis sessions).
Figures and Tables -
Analysis 5.2

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 2 Catheter‐related infection (per 1000 dialysis sessions).

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 3 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 5.3

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 3 Thrombosis (per 1000 catheter‐days).

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 4 Thrombosis (per 1000 dialysis sessions).
Figures and Tables -
Analysis 5.4

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 4 Thrombosis (per 1000 dialysis sessions).

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 5 Colonisation.
Figures and Tables -
Analysis 5.5

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 5 Colonisation.

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters.
Figures and Tables -
Analysis 5.6

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters.

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 7 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters.
Figures and Tables -
Analysis 5.7

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 7 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters.

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 8 Subgroup analysis: thrombosis (per 1000 catheter‐days) in tunnelled catheters.
Figures and Tables -
Analysis 5.8

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 8 Subgroup analysis: thrombosis (per 1000 catheter‐days) in tunnelled catheters.

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 9 Subgroup analysis: thrombosis (per 1000 catheter‐days) in non‐tunnelled catheters.
Figures and Tables -
Analysis 5.9

Comparison 5 Non‐antibiotic antimicrobial lock solutions versus control, Outcome 9 Subgroup analysis: thrombosis (per 1000 catheter‐days) in non‐tunnelled catheters.

Comparison 6 Sensitivity analysis: non‐antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 6.1

Comparison 6 Sensitivity analysis: non‐antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 6 Sensitivity analysis: non‐antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 6.2

Comparison 6 Sensitivity analysis: non‐antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).

Comparison 7 Combined antimicrobial lock solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 7.1

Comparison 7 Combined antimicrobial lock solutions versus control, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 7 Combined antimicrobial lock solutions versus control, Outcome 2 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 7.2

Comparison 7 Combined antimicrobial lock solutions versus control, Outcome 2 Thrombosis (per 1000 catheter‐days).

Comparison 8 Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).
Figures and Tables -
Analysis 8.1

Comparison 8 Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 1 Catheter‐related infection (per 1000 catheter‐days).

Comparison 8 Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).
Figures and Tables -
Analysis 8.2

Comparison 8 Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).

Summary of findings for the main comparison. Antimicrobial lock solutions vs control for preventing catheter‐related infections in patient undergoing haemodialysis

Antimicrobial lock solutions vs control for preventing catheter‐related infections in patient undergoing haemodialysis

Patient or population: CVC‐related infection
Setting: haemodialysis therapy
Intervention: antimicrobial lock solutions
Comparison: heparin and other lock solutions

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with heparin and other lock solutions

Risk with antimicrobial lock solutions

CVC ‐ related infections
assessed with: per 1000 days/catheter

Low

RR 0.38
(0.27 to 0.53)

2994
(27 RCTs)

⊕⊕⊝⊝
LOW 1 2 3 4 5

43 per 1.000

16 per 1.000
(12 to 23)

High

260 per 1.000

99 per 1.000
(70 to 138)

Thrombosis
assessed with: per 1000 days/catheter

Low

RR 0.79
(0.52 to 1.22)

2080
(14 RCTs)

⊕⊝⊝⊝
VERY LOW 6 7 8 9 10

6 per 1.000

5 per 1.000
(3 to 7)

High

330 per 1.000

261 per 1.000
(172 to 403)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: Confidence interval; RR: Risk ratio; OR: Odds ratio;

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

1 This judgment is based on the lack of information regarding the following criteria: random sequence generation, allocation concealment and blinding of outcome assesment

2 the statistics do not show serious heterogeneity and confidence intervals overlap.

3 the evidence is direct because the studies are in hemodialysis patients and the same sealing solutions the question of this review are used.

4 no imprecision is observed; because the decision regarding the use of antimicrobial lock solution is sealed better than heparin along the confidence interval

5 It is suspected a degree of publication bias

6 30% of the studies presented insufficient information to assess citerios of:random sequence generation, allocation concealment and blinding of outcome assesment

7 the statistical test showed a high heterogeneity and the confidence intervals do not overlap

8 the evidence is not indirect because the studies are in hemodialysis patients and the same sealing solutions the question of this review are used.

9 The 95% confidence interval of the pooled estimate ranges from 0.41 to 1.39, which is not narrow enough for a confident judgment of the effect size.

10 Publication bias is suspected as the funnel plot for this outcome shows asymmetry

Figures and Tables -
Summary of findings for the main comparison. Antimicrobial lock solutions vs control for preventing catheter‐related infections in patient undergoing haemodialysis
Comparison 1. All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

27

Rate Ratio (Fixed, 95% CI)

0.45 [0.38, 0.54]

2 Catheter‐related infection (per 1000 dialysis sessions) Show forest plot

2

Rate Ratio (Fixed, 95% CI)

0.49 [0.21, 1.12]

3 Thrombosis (per 1000 catheter‐days) Show forest plot

14

Rate Ratio (Random, 95% CI)

0.79 [0.52, 1.22]

4 Colonisation Show forest plot

2

Rate Ratio (Random, 95% CI)

0.37 [0.04, 3.36]

5 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters Show forest plot

21

Rate Ratio (Random, 95% CI)

0.40 [0.30, 0.53]

6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters Show forest plot

8

Rate Ratio (Random, 95% CI)

0.37 [0.16, 0.86]

7 Subgroup analysis: thrombosis (per 1000 catheter‐days) in tunnelled catheters Show forest plot

10

Rate Ratio (Random, 95% CI)

0.83 [0.50, 1.37]

8 Subgroup analysis: thrombosis (per 1000 catheter‐days) in non‐tunnelled catheters Show forest plot

4

Rate Ratio (Random, 95% CI)

0.66 [0.25, 1.72]

Figures and Tables -
Comparison 1. All antimicrobial (antibiotic plus non‐antibiotic plus the combination) solutions versus control
Comparison 2. Sensitivity analysis: all antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

18

Rate Ratio (Random, 95% CI)

0.47 [0.32, 0.68]

2 Thrombosis (per 1000 catheter‐days) Show forest plot

9

Rate Ratio (Random, 95% CI)

0.85 [0.48, 1.52]

Figures and Tables -
Comparison 2. Sensitivity analysis: all antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias
Comparison 3. Antibiotic lock solutions versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

13

Rate Ratio (Random, 95% CI)

0.30 [0.22, 0.42]

2 Catheter‐related infection (per 1000 dialysis sessions) Show forest plot

1

Rate Ratio (Random, 95% CI)

Totals not selected

3 Thrombosis (per 1000 catheter‐days) Show forest plot

5

Rate Ratio (Random, 95% CI)

0.76 [0.42, 1.38]

4 Colonisation Show forest plot

1

Rate Ratio (Random, 95% CI)

Totals not selected

5 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters Show forest plot

9

Rate Ratio (Random, 95% CI)

0.30 [0.18, 0.50]

6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters Show forest plot

4

Rate Ratio (Random, 95% CI)

0.14 [0.05, 0.36]

7 Subgroup analysis: thrombosis per 1000 catheter‐days in tunnelled catheters Show forest plot

3

Rate Ratio (Random, 95% CI)

0.61 [0.31, 1.23]

Figures and Tables -
Comparison 3. Antibiotic lock solutions versus control
Comparison 4. Sensitivity analysis: antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

7

Rate Ratio (Random, 95% CI)

0.37 [0.28, 0.48]

2 Thrombosis (per 1000 catheter‐days) Show forest plot

2

Rate Ratio (Random, 95% CI)

0.79 [0.24, 2.63]

Figures and Tables -
Comparison 4. Sensitivity analysis: antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias
Comparison 5. Non‐antibiotic antimicrobial lock solutions versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

11

Rate Ratio (Random, 95% CI)

0.65 [0.41, 1.05]

2 Catheter‐related infection (per 1000 dialysis sessions) Show forest plot

1

Rate Ratio (Random, 95% CI)

Totals not selected

3 Thrombosis (per 1000 catheter‐days) Show forest plot

8

Rate Ratio (Random, 95% CI)

0.85 [0.44, 1.66]

4 Thrombosis (per 1000 dialysis sessions) Show forest plot

1

Rate Ratio (Random, 95% CI)

Totals not selected

5 Colonisation Show forest plot

1

Rate Ratio (Random, 95% CI)

0.99 [0.27, 3.68]

6 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in tunnelled catheters Show forest plot

9

Rate Ratio (Random, 95% CI)

0.60 [0.40, 0.91]

7 Subgroup analysis: catheter‐related infection (per 1000 catheter‐days) in non‐tunnelled catheters Show forest plot

4

Rate Ratio (Random, 95% CI)

0.93 [0.48, 1.81]

8 Subgroup analysis: thrombosis (per 1000 catheter‐days) in tunnelled catheters Show forest plot

5

Rate Ratio (Random, 95% CI)

1.17 [0.57, 2.41]

9 Subgroup analysis: thrombosis (per 1000 catheter‐days) in non‐tunnelled catheters Show forest plot

4

Rate Ratio (Random, 95% CI)

0.66 [0.25, 1.72]

Figures and Tables -
Comparison 5. Non‐antibiotic antimicrobial lock solutions versus control
Comparison 6. Sensitivity analysis: non‐antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

9

Rate Ratio (Random, 95% CI)

0.65 [0.38, 1.12]

2 Thrombosis (per 1000 catheter‐days) Show forest plot

6

Rate Ratio (Random, 95% CI)

0.90 [0.43, 1.91]

Figures and Tables -
Comparison 6. Sensitivity analysis: non‐antibiotic lock solutions versus control excluding studies judged to be at high‐risk bias
Comparison 7. Combined antimicrobial lock solutions versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

4

Rate Ratio (Random, 95% CI)

0.26 [0.14, 0.49]

2 Thrombosis (per 1000 catheter‐days) Show forest plot

3

Rate Ratio (Random, 95% CI)

0.63 [0.22, 1.81]

Figures and Tables -
Comparison 7. Combined antimicrobial lock solutions versus control
Comparison 8. Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Catheter‐related infection (per 1000 catheter‐days) Show forest plot

2

Rate Ratio (Random, 95% CI)

0.16 [0.02, 1.03]

2 Thrombosis (per 1000 catheter‐days) Show forest plot

1

Rate Ratio (Random, 95% CI)

0.66 [0.18, 2.44]

Figures and Tables -
Comparison 8. Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias