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Four meta-analyses have evaluated the efficacy of various antibiotic lock solutions in chronic dialysis patients, and conclude that they significantly reduce catheter-related bloodstream infection. Drawbacks are the overall moderate trial quality and the short follow-up that does not allow excluding the development of resistance.682-685 However, the CDC, National Health Service, and Infectious Diseases Society of America guidelines strongly recommend against routinely using antibiotic lock solutions in CVC, because of their potential to promote fungal infections, antimicrobial resistance, and systemic toxicity.641,664,665 Mentioned exceptions are long-term cuffed and tunneled catheters with history of multiple catheter-related bloodstream infections despite maximal adherence to aseptic technique,641,665 patients with limited venous access and history of recurrent catheter-related bloodstream infection, or patients with heightened risk of severe sequelae from a catheter-related bloodstream infection.664
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