Su1996 - Loading and Tracking Intestinal Organoids with Fluorescent Plga Nanoparticles

Background: Catheter-related blood stream infection (CRBSI) is a serious complication for patients on parenteral nutrition (PN).Antimicrobial lock solutions have been used as a prophylaxis against CRBSI, however their efficacy in the PN population is unclear.Objective: To conduct a systematic review to assess the use of antimicrobial lock solutions for the prevention of CRBSI in patients on PN.Methods: We performed a systematic search of EMBASE, MEDLINE, CENTRAL, ISI Web of Knowledge (from earliest date to July 2017).Search terms included PN, citrate, ethanol, taurolidine, antibiotic lock and antimicrobial lock.We included randomized controlled trials (RCT) and observational studies evaluating the use of antimicrobial locks compared to control solutions (heparin or saline) to prevent CRBSI in adult and pediatric patients on PN.Two reviewers independently performed study selection and data extraction.Study quality was assessed using the Cochrane Risk of bias tool and ROBINS-I for RCTs and observational studies, respectively.We stratified the studies based on patient risk level (high-risk vs non high-risk) for CRBSI, the type of antimicrobial lock, and study design (RCT vs observational).Results: The literature search identified 860 citations of which 23 studies (3 RCTs, 20 observational) were selected, totaling 601 patients.Twelve studies assessed an ethanol lock solution, 10 taurolidine, 1 vancomycin and 1 tobramycin.All 17 studies (1 RCT, 16 observational) in high-risk patients showed lower CRBSI rates in the group with antimicrobial locks compared to controls, with 16 studies (1 RCT, 15 observational) reporting statistically significant results.In non high-risk patients (n=7), results were variable with only 2 studies showing such benefits.The remaining studies in non high-risk patients (2 RCTs and 3 observational) did not show statistically significant between-group differences.However all studies, including the RCTs were at high risk of bias.Study quality including unadjusted confounding and modest sample sizes threaten the validity of the findings.Methodological and clinical heterogeneity precluded pooling of the data by meta-analysis.Conclusion: This systematic review suggests that there exists insufficient high-quality evidence to support the use of antimicrobial locks as prophylaxis for CRBSI in PN patients.Most data stem from observational studies, with only three RCTs; marked methodological limitations coupled to heterogeneity for the main outcomes precluded the performance of any meaningful meta-analysis.High quality studies are needed to define the benefits of antimicrobial locks in high-risk population, assess the role of antimicrobial locks in non high-risk patients, and define optimal context for the use of antimicrobial locks.Summary of catheter related blood stream infection (CRBSI) rates (events per 1000 catheterdays) in studies with high-risk patients S-659AGA Abstracts * The study by Davidson reported outcomes with 2 types of locks (ethanol and vancomycin).The results are reported separately in the table.CRBSI = catheter-related blood stream infection, RCT= randomized control trial, Tx = treatment Summary of catheter-related blood stream infection (CRBSI) rates (event per 1000 catheterdays) in studies with non high-risk patients CI = confidence interval, CRBSI= catheter-related blood stream infection, RCT= randomized control trial, Tx= treatment.*Statistical significance only reported in subgroup on ethanol lock for greater than 3 months.**Authors reported an adjusted CRBSI incidence ratio for heparin compared to taurolidine of 5.9(95%CI 3.9-8.7)Su1996