Use of antibiotic lock therapy in central line-associated bloodstream infections in cancer patients: A systematic review

Purpose: To assess the use of antibiotic lock therapy (ALT) in prevention of central line-associated bloodstream infections (CLABSI) in cancer patients and provide evidence-based recommendations.

Methods: A comprehensive literature search was performed through Medline and Google Scholar  using the search terms “antimicrobial lock solution”, “antibiotic lock solution”, “hematology and oncology”,” cancer”,   and “central venous catheter”.  Article reference lists were also reviewed.  Published data were considered appropriate if antibiotic lock solutions were used in a prophylactic manner, study population included cancer patients, and lock therapy outcomes of interest were reported.  Case reports and case series were acceptable. In vitro data and published literature omitting outcomes such as clinical effectiveness, dwell times and type of solution were excluded. Clinical effectiveness was recognized by the rate of infections per 1000 catheter days. Studies were reviewed independently by three seasoned investigators.  All data were compiled and analyzed to provide evidence-based recommendations.   

Results: A total of 70 articles were identified through the search methodology and 24 of those were investigations in a cancer population.  Following all exclusions, study investigators identified 11 published articles including: 8 randomized controlled trials, 1 prospective open-label trial, 1 case report and 1 brief report. Solutions studied included: vancomycin (5), ethanol (2), minocycline/EDTA (2), ciprofloxacin (1) and amikacin (1).  Other than minocycline, all antimicrobials were in combination with heparin.  The mean percent reduction of using ALT versus the control was 43.7%.  No severe adverse events were reported.

Conclusion: The use of antibiotic lock therapy in a prophylactic modality decreases the incidence of CLABSI in cancer patients.  Clinicians may consider ALT as a prophylactic option for reducing CLABSI. Future trials should focus on prospective evaluation of clinical effectiveness of various lock solutions.