No CrossRef data available.
Article contents
Role of EDTA lock solution in preventing catheter-related bloodstream infections or central line-associated bloodstream infections: a systematic review and meta-analysis
Published online by Cambridge University Press: 05 September 2025
Abstract
Objective:
Catheter-related bloodstream infections (CRBSI) or central line-associated bloodstream infections (CLABSI) occur frequently with long-term indwelling catheters. EDTA (Ethylenediaminetetraacetic acid) and other catheter lock solutions can prevent CRBSI/CLABSI. This study aimed to identify the role of EDTA lock solution in preventing CRBSI/CLABSI compared to the non-EDTA lock solutions.
Materials and Methods:
Eligible studies comparing the effectiveness of EDTA versus a control group on averting CRBSI or CLABSI were identified through searches across PubMed, Embase, Scopus, Cochrane CENTRAL, medRxiv, bioRxiv, and ClinicalTrials.gov. The secondary outcomes were catheter colonization, catheter survival, and catheter thrombosis. The relative risk for all the outcomes was calculated.
Results:
This meta-analysis included eight studies (403 EDTA vs 425 control patients) and demonstrated a significant reduction in CRBSI/CLABSI with EDTA (15 vs 71 events; RR: 0.18; 95% CI: 0.10–0.33; P < 0.00001). Catheter colonization also decreased significantly (8 vs 38 events; OR: 0.11; 95% CI: 0.05–0.29). EDTA improved catheter survival in hemodialysis patients (OR: 3.77; 95% CI: 1.23–11.61; P < 0.02) but showed no significant effect on thrombolytic treatment or all-cause mortality. Subgroup analyses supported these findings, with no publication bias detected.
Conclusion:
EDTA significantly reduces CRBSI/CLABSI and catheter colonization, improves catheter survival, but does not affect thrombolytic treatment or mortality. Evidence certainty varies across outcomes.
Information
- Type
- Review
- Information
- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America
Footnotes
*
These two senior authors (AG and SC1) contributed equally.
References
Raad, I, Chaftari, AM, Zakhour, R, et al. Successful salvage of central venous catheters in patients with catheter-related or central line-associated bloodstream infections by using a catheter lock solution consisting of minocycline, EDTA, and 25% ethanol. Antimicrob Agents Chemother 2016;60:3426–3432.10.1128/AAC.02565-15CrossRefGoogle ScholarPubMed
Kanaa, M, Wright, MJ, Akbani, H, Laboi, P, Bhandari, S, Sandoe, JAT. Cathasept line lock and microbial colonization of tunneled hemodialysis catheters: a multicenter randomized controlled trial. Am J Kidney Dis Off J Natl Kidney Found 2015;66:1015–1023.10.1053/j.ajkd.2015.04.047CrossRefGoogle ScholarPubMed
Abdul Salim, S, Masoud, AT, Thongprayoon, C, et al. Systematic review and meta-analysis of antibiotic and antimicrobial lock solutions for prevention of hemodialysis catheter-related infections. ASAIO J Am Soc Artif Intern Organs 1992 2021;67:1079–1086.Google ScholarPubMed
Baang, JH, Inagaki, K, Nagel, J, et al. Inpatient Diagnosis and Treatment of Catheter-Related Bloodstream Infection [Internet]. Ann Arbor (MI): Michigan Medicine University of Michigan; 2023 [cited 2024 Sep 26]. (Michigan Medicine Clinical Care Guidelines). Available from: https://www.ncbi.nlm.nih.gov/books/NBK589895/
Google Scholar
Bleyer, AJ, Mason, L, Russell, G, Raad, II, Sherertz, RJ. A randomized, controlled trial of a new vascular catheter flush solution (Minocycline-EDTA) in temporary hemodialysis access. Infect Control Hosp Epidemiol 2005;26:520–524.10.1086/502578CrossRefGoogle ScholarPubMed
Sun, Y, Wan, G, Liang, L. Taurolidine lock solution for catheter-related bloodstream infections in pediatric patients: a meta-analysis. PLOS ONE 2020;15:e0231110.10.1371/journal.pone.0231110CrossRefGoogle ScholarPubMed
Raad, I, Chatzinikolaou, I, Chaiban, G, et al. In vitro and ex vivo activities of minocycline and EDTA against microorganisms embedded in biofilm on catheter surfaces. Antimicrob Agents Chemother 2003;47:3580–3585.10.1128/AAC.47.11.3580-3585.2003CrossRefGoogle ScholarPubMed
Kite, P, Eastwood, K, Sugden, S, Percival, SL. Use of in vivo-generated biofilms from hemodialysis catheters to test the efficacy of a novel antimicrobial catheter lock for biofilm eradication in vitro. J Clin Microbiol 2004;42:3073–3076.10.1128/JCM.42.7.3073-3076.2004CrossRefGoogle ScholarPubMed
Campos, RP, do Nascimento, MM, Chula, DC, Riella, MC. Minocycline-EDTA lock solution prevents catheter-related bacteremia in hemodialysis. J Am Soc Nephrol JASN 2011;22:1939–1945.10.1681/ASN.2010121306CrossRefGoogle ScholarPubMed
Ferreira Chacon, JM, Hato de Almeida, E, de Lourdes Simões, R, et al. Randomized study of minocycline and edetic acid as a locking solution for central line (port-a-cath) in children with cancer. Chemotherapy 2011;57:285–291.10.1159/000328976CrossRefGoogle ScholarPubMed
Rijnders, B, DiSciullo, GJ, Csiky, B, et al. Locking hemodialysis catheters with trimethoprim-ethanol-Ca-EDTA to prevent bloodstream infections: a randomized, evaluator-blinded clinical trial. Clin Infect Dis Off Publ Infect Dis Soc Am 2019;69:130–13610.1093/cid/ciy840CrossRefGoogle ScholarPubMed
Hill, J, Garner, R. Efficacy of 4% tetrasodium ethylenediaminetetraacetic acid (T-EDTA) catheter lock solution in home parenteral nutrition patients: A quality improvement evaluation. J Vasc Access 2021;22:533–539.10.1177/1129729820946916CrossRefGoogle ScholarPubMed
Nori, US, Manoharan, A, Yee, J, Besarab, A. Comparison of low-dose gentamicin with minocycline as catheter lock solutions in the prevention of catheter-related bacteremia. Am J Kidney Dis Off J Natl Kidney Found 2006;48:596–605.10.1053/j.ajkd.2006.06.012CrossRefGoogle ScholarPubMed
Chatzinikolaou, I, Zipf, TF, Hanna, H, et al. Minocycline-ethylenediaminetetraacetate lock solution for the prevention of implantable port infections in children with cancer. Clin Infect Dis 2003;36:116–119.10.1086/344952CrossRefGoogle ScholarPubMed
Luiz, MVSJ, Scavone, C, Tzanno, C. The CLOCK trial, a double-blinded randomized controlled trial: Trisodium citrate 30% and minocycline 3 mg/mL plus EDTA 30 mg/mL are effective and safe for catheter patency maintenance among CKD 5D patients on hemodialysis. Hemodial Int Int Symp Home Hemodial 2017;21:294–304.10.1111/hdi.12492CrossRefGoogle Scholar
Dang, FP, Li, HJ, Wang, RJ, et al. Comparative efficacy of various antimicrobial lock solutions for preventing catheter-related bloodstream infections: A network meta-analysis of 9099 patients from 52 randomized controlled trials. Int J Infect Dis IJID Off Publ Int Soc Infect Dis 2019;87:154–165.Google ScholarPubMed
Milstone, AM, Reich, NG, Advani, S, et al. Catheter dwell time and CLABSIs in neonates with PICCs: a multicenter cohort study. Pediatrics 2013;132:e1609–e1615.10.1542/peds.2013-1645CrossRefGoogle ScholarPubMed
Zwiech, R, Adelt, M, Chrul, S. A taurolidine-citrate-heparin lock solution effectively eradicates pathogens from the catheter biofilm in hemodialysis patients. Am J Ther 2016;23:e363–e368.10.1097/MJT.0b013e31828d4610CrossRefGoogle ScholarPubMed
Venkatesh, M, Rong, L, Raad, I, Versalovic, J. Novel synergistic antibiofilm combinations for salvage of infected catheters. J Med Microbiol 2009;58:936–944.10.1099/jmm.0.009761-0CrossRefGoogle ScholarPubMed
Rijnders, BJA, Van Wijngaerden, E, Peetermans, WE. Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis Off Publ Infect Dis Soc Am 2002;35:1053–1058.10.1086/342905CrossRefGoogle ScholarPubMed
Sherertz, RJ, Heard, SO, Raad, II. Diagnosis of triple-lumen catheter infection: comparison of roll plate, sonication, and flushing methodologies. J Clin Microbiol [Internet]. 1997;35:641–646. Available from: https://pubmed.ncbi.nlm.nih.gov/9041404/
10.1128/jcm.35.3.641-646.1997CrossRefGoogle ScholarPubMed
Bari, AK, Belalekar, TS, Poojary, A, Rohra, S. Combination drug strategies for biofilm eradication using synthetic and natural agents in KAPE pathogens. Front Cell Infect Microbiol 2023;13:1155699.10.3389/fcimb.2023.1155699CrossRefGoogle ScholarPubMed
Ho, KM. Use of chlorhexidine-impregnated dressing to prevent vascular and epidural catheter colonization and infection: a meta-analysis. J Antimicrob Chemother 2006;58:281–287.10.1093/jac/dkl234CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Vital signs: central line–associated blood stream infections—United States, 2001, 2008, and 2009. Ann Emerg Med 2011;58:447–450.10.1016/j.annemergmed.2011.07.035CrossRefGoogle Scholar
Chakraborty et al. supplementary material
Chakraborty et al. supplementary material
File
119.6 KB