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Efficacy of Heparin–Vancomycin–Amikacin Combination Lock in Preventing Catheter-Related Infections in Haemodialysis Patients: A Double-Blind Randomized Clinical Trial Publisher



Arabzadeh AA1 ; Iranikia M1 ; Pourfarzi F2 ; Shahrami B3 ; M Kebar S4
Authors
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Authors Affiliations
  1. 1. Department of Surgery, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
  2. 2. Digestive Disease Research Centre, Ardabil University of Medical Science, Ardabil, Iran
  3. 3. Department of Clinical Pharmacy, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Department of Internal Medicine, Ardabil University of Medical Sciences, Ardabil, Iran

Source: Infection Prevention in Practice Published:2025


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. © 2025