Antimicrobial locks for the prevention of central line associated bloodstream infections in pediatric patients: a systematic review and network meta-analysis.

BACKGROUND

Central-line-associated bloodstream infections (CLABSI) impart substantial morbidity and mortality worldwide Neonates and other pediatric patients with chronic conditions that require long-term central access are at the highest risk and often develop CLABSIs despite high compliance with evidence-based prevention bundles. One potential adjunctive prevention strategy is the use of antimicrobial locks; however, data concerning the effectiveness of locks in preventing pediatric CLABSIs are mixed.

METHODS

We conducted a systematic review of randomized controlled trials and, separately, observational studies of pediatric patients who received antimicrobial locks for primary and secondary CLABSI prevention since antimicrobial locks were described in 1990. We conducted meta-analyses for both study designs to evaluate the effectiveness of antimicrobial locks in reducing CLABSIs.

RESULTS

Thirty-five studies were included in the systematic review; twenty-six studies were included in the meta-analyses. Among the 11 randomized controlled trials eligible for inclusion in the meta-analysis, there was a 48% lower rate of CLABSIs in those with antimicrobial locks than in those with standard locks (pooled IRR: 0.52 (p = 0.016, [95% CI 0.317, 0.86], I2: 52%). This reduction in CLABSIs varied among patient populations and lock types. Among 15 observational studies eligible for inclusion in the meta-analysis, there was a 70% reduction in the rate of CLABSIs with antimicrobial locks compared with standard locks (pooled IRR: 0.31, p = 0.001, [95% CI 0.17, 0.57], I2: 92%); however, this reduction was not significant among all subgroups or between lock types. Significant bias was noted in the observational studies.

CONCLUSIONS

This review highlights the need for well-designed studies to determine the clinical effectiveness of antimicrobial locks for primary and secondary CLABSI prevention in specific pediatric populations and to determine whether there is differential impact by lock type.