Antimicrobial Lock Fluids and CLABSI

Central line catheters are often used in medicine to administer fluids, collect samples, and deliver drugs.  The insertion wounds and devices themselves are prone to contamination which may cause infection. Central Line Associated Bloodstream Infections (CLABSIs) are especially deadly and expensive, affecting about 5% of hospitalized patients with mortality of 12-25% (CDC).  A single infection costs approximately $45,000 to treat. 

 

A common practice is to fill or “lock” the catheter with heparinized saline when not in use.  Locking catheters with such fluid prevents blood clots but provides an ideal environment for opportunistic microorganisms.

 

CLABSIs were recently studied by meta-analysis by Dr. Zacharioudakis et al. at Rhode Island Hospital.  His group found that when antimicrobial catheter lock solutions were used in place of ordinary lock solutions, infections were reduced by a whopping 69%. The study looked at active ingredients including Gentamicin, Vancomycin and Taurolidine, which is a non-antibiotic antimicrobial agent. The study showed reduction in CLABSI from antimicrobial lock fluids regardless of which antimicrobial agent was used.  In addition, antimicrobial lock solutions worked equally well against antibiotic resistant microbes. 

 

The study did not find any evidence that the use of antimicrobial lock solutions was detrimental to catheter integrity, so there is a strong incentive to expand studies into non-antibiotic antimicrobial lock agents to reduce the risk of CLABSI.