Use of Vancomycin-Containing Lock or Flush Solutions for Prevention of Bloodstream Infection Associated with Central Venous Access Devices: A Meta-Analysis of Prospective, Randomized Trials

N. Safdar, D. G. Maki
2006 Clinical Infectious Diseases  
Background. Prolonged exposure to central venous access devices carries significant risk of device-associated bloodstream infection (BSI), which is associated with morbidity, added health care costs, and attributable mortality. We aimed to determine the efficacy of vancomycin-heparin lock or flush solution in preventing BSI in patients being treated with long-term central venous intravascular devices (IVDs). Methods. We collected data from January 1966 to January 2006 from multiple computerized
more » ... ltiple computerized databases and compiled reference lists of identified articles. We identified prospective, randomized controlled trials comparing a vancomycin-heparin lock or flush solution with heparin alone for prevention of BSI associated with long-term central venous IVDs. Using a standardized form, we abstracted data regarding study quality, patient characteristics, and incidence of BSI. Results. Seven randomized, controlled trials involving a total of 463 patients being treated with IVDs met the inclusion criteria; 5 studies were conducted among patients with cancer, 1 among a critically ill neonatal population, and 1 among patients with cancer or who required parenteral nutrition. We could not detect publication bias. The summary risk ratio with a vancomycin heparin-lock solution for IVD-associated BSI was 0.49 (95% confidence interval [CI], 0.26-0.95; ). Results of the test for heterogeneity were statistically significant; however, when P p .03 a single study was removed from the analysis, heterogeneity was no longer present. Use of vancomycin as a true lock solution-instilling it for a defined period, rather than simply flushing it directly through the device-conferred a much greater benefit, with a risk ratio of 0.34 (95% CI, 0.12-0.98; ). The 2 studies that performed P p .04 prospective surveillance cultures to identify colonization or infection by vancomycin-resistant organisms did not find an increased risk. Conclusions. Use of a vancomycin lock solution in high-risk patient populations being treated with long-term central IVDs reduces the risk of BSI. The use of an anti-infective lock solution warrants consideration for patients who require central access but who are at high risk of BSI, such as patients with malignancy or low-birthweight neonates.
doi:10.1086/505976 pmid:16838237 fatcat:7twmfzetivbbdboxvuztobx7bu