Schoot, R.A., van Dalen, E.C., van Ommen, C.H., & van de Wetering, M.D. (2013). Antibiotic and other lock treatments for tunnelled central venous catheter-related infections in children with cancer. Cochrane Database of Systematic Reviews, 6, CD008975.

STUDY PURPOSE: To investigate antibiotics or other lock treatments in comparison to a control intervention for the treatment of central venous catheter (CVC)-related infections in children with cancer

TYPE OF STUDY: Systematic review

DATABASES USED: CENTRAL (2011), MELINE/PubMed (1945–August 2011), and EMBASE/Ovid (1980–August 2011); reference lists from relevant articles and conference proceedings (SIOP, 2006–2010; American Society of Clinical Oncology, 2006–2010; Multinational Association of Supportive Care in Cancer, 2006–2011; American Society of Hematology, 2006–2010; and International Society on Thrombosis and Haemostasis, 2006–2011); and scanned ISRCTN for ongoing trials

KEYWORDS: See appendices attached.

INCLUSION CRITERIA: Randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comparing one lock treatment with another, or with systemic antibiotics alone, to treat CVC-related infections in children with cancer; cohort studies also were included for adverse events.

EXCLUSION CRITERIA: Adults included in the analyses, studies focused on infection prevention, use of coated catheters, observational studies, no control comparisons, case report studies, and review studies

TOTAL REFERENCES RETRIEVED = 508

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Two review authors searched the databases and reviewed articles for inclusion criteria. Bias assessment was conducted, and if no agreement was reached, a third party was included in the assessment. Pooled analysis was conducted using Review Manager 5 when studies met methodologic quality and were comparable; otherwise, descriptive summaries were conducted. Comparisons included the creation of forest plots. The comprehensive search of multiple databases, meeting proceedings, and ongoing trials to elicit articles for the evaluation of RCTs, CCTs, and cohort studies was appropriate for this evaluation.

• FINAL NUMBER STUDIES INCLUDED = 12 (not all included in all of the analyses)
• SAMPLE RANGE ACROSS STUDIES = 23–68
• TOTAL PATIENTS INCLUDED IN REVIEW = 132
• KEY SAMPLE CHARACTERISTICS: Children with cancer (aged 0–18 years) who incurred a CVC-related infection

• PHASE OF CARE: Active antitumor treatment     
• APPLICATIONS: Pediatrics

No significant differences were found between the use of ethanol or urokinase lock treatments with systemic antibiotics and systemic antibiotics alone for the outcomes of number cured, number of recurrent CVC-related infections, days until first negative blood culture, number of early removal of CVCs, intensive care unit admissions, or sepsis.

No benefit of urokinase or ethanol lock in addition to systemic antibiotics was found.

• Small sample sizes
• Short follow-up time
• Some CVC malfunctioning was reported.
• No adverse events were reported in the cohort studies.
• No RCTs or CCTs that used antibiotic lock treatment alone were found in the literature.

No added benefit was found in the use of urokinase or ethanol lock treatment in addition to systemic antibiotics for the treatment of CVC-related infections in children undergoing treatment for cancer.