Effectiveness of different antibiotic lock solutions on catheter-related infections of hemodialysis patients: a systematic review and meta-analysis.

BACKGROUND: Antibiotic lock therapy (ALT) delivers high-concentration antimicrobials into catheter lumens and has been proposed to prevent infections in hemodialysis (HD) patients. METHODS: We conducted a systematic review and meta-analysis of randomized clinical trials (RCTs) and quasi-experimental studies comparing ALT with non-antibiotic or no-lock solutions in adults on HD. Six databases (PubMed, Embase, Scopus, Web of Science, Cochrane CENTRAL, CINAHL) were searched through 27 June 2025, identifying 17 studies involving 3,482 catheters. Two independent reviewers extracted data and assessed bias using the Cochrane RoB 2. Random-effects models yielded pooled risk ratios (RR) and incidence rate ratios (IRR) with 95% confidence intervals (CI). RESULTS: ALT reduced catheter-related bloodstream infections (CRBSI) by 63% (RR= 0.37, 95% CI: 0.29-0.49; p < 0.001). Overall, catheter-related infection incidence rates fell (IRR 0.24, 95% CI: 0.15-0.38; p < 0.001) despite potential for publication bias (Egger's p = 0.003). No significant effects appeared for exit-site infections (ESI) (RR= 0.90; p = 0.59), thrombosis (RR= 0.73; p = 0.23), or mortality (RR= 0.58; p = 0.09). GRADE assessed the evidence for CRBSI as having high certainty, while evidence for ESI was moderate, and evidence for other outcomes ranged from low to very low. CONCLUSIONS: ALT significantly reduces CRBSI in HD patients and can be considered as a preventive adjunct.