Soluciones de sellado con antimicrobianos para la prevención de las infecciones relacionadas con el catéter en la hemodiálisis
Información
- DOI:
- https://doi.org/10.1002/14651858.CD010597.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 03 abril 2018see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Riñón y trasplante
- Copyright:
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- Copyright © 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
Altmetric:
Citado por:
Autores
Contributions of authors
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Draft the protocol: MCA, MIC, JCC, LML, MC
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Develop a search strategy: MCA, MIC
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Search for studies: MCA, MIC
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Obtain copies of studies: MCA
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Study selection: MCA, MIC
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Extract data from studies: NR, MR
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Enter data into RevMan: MCA, MIC, JCC
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Carry out the analysis: JCC, MCA, MIC
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Interpret the analysis: MCA, MIC, JCC, LML
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Draft the final review: MCA, MIC, JCC, LML
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Disagreement resolution: MCA, MIC, JCC, LML
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Update the review: MCA, MIC, JCC, LML
Sources of support
Internal sources
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New Source of support, Other.
External sources
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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 | |
| 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 | |
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- *Renal Dialysis;
- Anti‐Bacterial Agents [therapeutic use];
- Anti‐Infective Agents [*therapeutic use];
- Anticoagulants [therapeutic use];
- Catheter‐Related Infections [epidemiology, *prevention & control];
- Catheterization, Central Venous [*adverse effects];
- Heparin [therapeutic use];
- Incidence;
- Randomized Controlled Trials as Topic;
- Venous Thrombosis [epidemiology, *prevention & control];
Medical Subject Headings Check Words
Humans;
PICO
Study selection flow diagram
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.
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).
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).
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).
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.
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.
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).
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).
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).
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.
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.
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).
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).
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).
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.
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.
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).
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).
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).
Comparison 8 Sensitivity analysis: combined antimicrobial lock solutions versus control excluding studies deemed with high‐risk bias, Outcome 2 Thrombosis (per 1000 catheter‐days).
| Antimicrobial lock solutions vs control for preventing catheter‐related infections in patient undergoing haemodialysis | ||||||
| Patient or population: CVC‐related infection | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Certainty of the evidence | Comments | |
| Risk with heparin and other lock solutions | Risk with antimicrobial lock solutions | |||||
| CVC ‐ related infections | Low | RR 0.38 | 2994 | ⊕⊕⊝⊝ | ||
| 43 per 1.000 | 16 per 1.000 | |||||
| High | ||||||
| 260 per 1.000 | 99 per 1.000 | |||||
| Thrombosis | Low | RR 0.79 | 2080 | ⊕⊝⊝⊝ | ||
| 6 per 1.000 | 5 per 1.000 | |||||
| High | ||||||
| 330 per 1.000 | 261 per 1.000 | |||||
| *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). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 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 | ||||||
| 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] | |
| 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] | |
| 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] | |
| 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] | |
| 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] | |
| 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] | |
| 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] | |
| 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] | |
