Efficacy of heparin–vancomycin–amikacin combination lock in preventing catheter-related infections in haemodialysis patients: a double-blind randomized clinical trial

Abstract

Background

Haemodialysis patients with tunnelled central venous catheters (CVCs) are at high risk for catheter-related infections (CRIs), which can lead to serious complications, prolonged hospitalizations, and increased healthcare costs. The use of antibiotic lock solutions may help prevent these infections. This study evaluates the efficacy of a heparin–vancomycin–amikacin combination lock solution in preventing CRIs compared with heparin alone in haemodialysis patients.

Methods

This single-centre, double-blind randomized clinical trial involved 60 haemodialysis patients with tunnelled CVCs. Patients were randomly assigned to receive either a heparin 5000 units/mL lock (Group A) or a combination of heparin 5000 units/mL, vancomycin 500 mg/mL, and amikacin 500 mg/mL lock (Group B). The primary outcome was the incidence of CRIs, diagnosed using CDC criteria, over a 6-month follow-up period.

Findings

Group B demonstrated a significantly lower incidence of CRIs compared to Group A (P=0.001). Additionally, the mean number of CRI episodes per patient and the CRI rate per 1000 catheter days were significantly lower in Group B (P=0.028 and 0.042, respectively). The rate of catheter removal due to infection was also significantly reduced in Group B (P=0.029). No significant differences in infection timing were observed, although Group B showed later infection onset. No adverse drug reactions were reported.

Conclusions

The heparin–vancomycin–amikacin combination lock solution was more effective in preventing CRIs than heparin alone in haemodialysis patients. Further studies with larger sample sizes and longer follow-up are needed to confirm its long-term benefits and assess potential risks, including antibiotic resistance.