***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: BACKGROUND Catheter-restricted antibiotic lock solutions were found to be effective in the prevention of  catheter-related bacteremia ( CRB ) , but insufficient data are available about the ideal agent and dose . We hypothesized that a low concentration of gentamicin would be as effective as the high doses studied in the past . METHODS In this prospect i ve , open-labeled , r and omized , clinical trial of patients on long-term hemodialysis therapy , patients were r and omly assigned to administration of an antibiotic lock solution of gentamicin/citrate ( 4 mg/mL ) , minocycline/EDTA , or the control solution of heparin . Patients were followed up until the study end point of CRB was reached or a censoring event occurred . Interim data analysis was performed after 6 months to assess data safety ; efficacy was noted and the study was terminated early . RESULTS Sixty-two patients were enrolled into the study , evenly distributed in 3 arms , with data from 1 patient excluded from analysis . Seven of 20 patients in the heparin group ( 4.0 events/1,000 catheter days ) , 1 of 21 patients in the minocycline group ( 0.4 events/1,000 catheter days ) , and none of 20 patients in the gentamicin group developed bacteremia . Results were statistically significant by using 2-tailed Fisher exact test ; heparin versus gentamicin , P = 0.008 , and heparin versus minocycline , P = 0.020 . CONCLUSION Antibiotic lock solutions are superior to the st and ard heparin lock alone in the prevention of CRBs , and low-dose gentamicin solution has efficacy similar to that of greater concentrations used in previous studies INTRODUCTION Catheter-related infection is associated with increased all-cause mortality and morbidity in hemodialysis patients . This study aim ed to evaluate an antimicrobial lock solution ( cloxacillin and heparin ) in temporary noncuffed double-lumen catheters for long-term intermittent hemodialysis as a method of preventing catheter-related infection . MATERIAL S AND METHODS Patients on hemodialysis with noncuffed temporary double lumen catheter were r and omly divided into 2 groups . Fifty patients received a solution containing cloxacillin , 100 mg/mL , plus heparin , 1000 IU/mL as a 2.5-mL solution instilled in each of catheter lumens after dialysis session . Another 50 patients received only heparin . They were allowed to dwell until the next session of dialysis . RESULTS One catheter-related bacteremia was observed in the antibiotic group whereas catheter-related bacteremia was observed in 8 of those who received heparin only . The rate of catheter-related bacteremia episodes were 0.5 per 1000 catheter-days in the antibiotic group versus 7.8 per 1000 catheter-days in the control group ( P = .02 ) . CONCLUSIONS In the present study , application of cloxacillin as antibiotic lock solution for dialysis catheters result ed in a considerable reduction in catheter-related bacteremia rate BACKGROUND AND OBJECTIVES Citrate 4 % has antithrombotic and antibacterial properties , which makes it a potentially superior alternative to heparin as an indwelling intraluminal locking agent . DESIGN , SETTING , PARTICIPANTS , AND MEASUREMENTS Sixty-one prevalent hemodialysis ( HD ) patients dialyzing with a tunneled cuffed HD catheter were r and omized in a pilot study to receive either heparin 5000 U/ml or citrate 4 % as a locking agent after HD . The primary outcomes were the development of catheter dysfunction ( defined as a blood pump speed < 250 ml/min or the use of tissue plasminogen activator ) and catheter-associated bacteremia . The secondary outcomes were the development of an exit-site infection or bleeding complications ( either local or systemic ) . RESULTS Citrate had comparable catheter dysfunction episodes to heparin ( 13/32 [ 41 % ] cases versus 12/29 [ 41 % ] cases , respectively ) . There were no differences in the development of catheter-associated bacteremia ( 2.2/1000 catheter days citrate versus 3.3/1000 catheter days heparin group ; P = 0.607 ) or exit-site infection ( 2.2/1000 catheter days for both groups ) . CONCLUSIONS The preliminary findings from our pilot study demonstrate that 4 % citrate is effective in maintaining catheter patency and does not appear to have any increased incidence of infections . Because citrate is significantly cheaper and has a more favorable side effect profile than heparin , it can be considered a potentially better locking agent in HD catheters Background Catheter-related bacteraemias ( CRBs ) contribute significantly to morbidity , mortality and health care costs in dialysis population s. Despite international guidelines recommending avoidance of catheters for haemodialysis access , hospital admissions for CRBs have doubled in the last decade . The primary aim of the study is to determine whether weekly instillation of 70 % ethanol prevents CRBs compared with st and ard heparin saline . Methods / design The study will follow a prospect i ve , open-label , r and omized controlled design . Inclusion criteria are adult patients with incident or prevalent tunneled intravenous dialysis catheters on three times weekly haemodialysis , with no current evidence of catheter infection and no personal , cultural or religious objection to ethanol use , who are on adequate contraception and are able to give informed consent . Patients will be r and omized 1:1 to receive 3 mL of intravenous- grade 70 % ethanol into each lumen of the catheter once a week and st and ard heparin locks for other dialysis days , or to receive heparin locks only . The primary outcome measure will be time to the first episode of CRB , which will be defined using st and ard objective criteria . Secondary outcomes will include adverse reactions , incidence of CRB caused by different pathogens , time to infection-related catheter removal , time to exit site infections and costs . Prospect i ve power calculations indicate that the study will have 80 % statistical power to detect a clinical ly significant increase in median infection-free survival from 200 days to 400 days if 56 patients are recruited into each arm . Discussion This investigator-initiated study has been design ed to provide evidence to help nephrologists reduce the incidence of CRBs in haemodialysis patients with tunnelled intravenous catheters . Trial Registration Australian New Zeal and Clinical Trials Registry Number : As a result of the high rate of infection , the NKF-K/DOQI guidelines recommended that an uncuffed catheter ( UC ) should not be used for longer than three weeks . However , the findings of the Dialysis Outcomes and Practice Patterns Study recognized that 48 % of new hemodialysis patients in the US and 75 % in Europe used UC for temporary access during arteriovenous fistula or graft maturation . The antibiotic lock technique ( ALT ) has been recommended to prevent catheter-related bacteremia ( CRB ) . Here , we prospect ively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB .  A total of 120 new hemodialysis patients requiring a temporary catheter while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study . Patients with a UC were r and omly assigned to receive either an antibiotic-heparin lock solution ( antibiotic group : cefazolin 10 mg/ml , gentamicin 5 mg/ml , heparin 1000 U/ml ) or a heparin lock solution ( no-antibiotic group : heparin 1000 U/ml ) as a catheter lock solution during the interdialytic period . The end point of the trial was CRB . CRB developed in seven ( 11.7 % ) patients in the no-antibiotic group ( Staphylococcus aureus , two ; Staphylococcus epidermidis , five ) whereas only one patient in the antibiotic group had S. aureus bacteremia . CRB rates per 1000 catheter-days were 0.44 in the antibiotic group versus 3.12 in the no-antibiotic group ( P=0.031 ) . Kaplan-Meier analysis also showed that mean CRB-free catheter survival of 59 days ( 95 % CI , 58 - 61 days ) in the antibiotic group was greater than that in the no-antibiotic group ( 55 days ; 95 % CI , 50 - 59 days ) . The results suggest that ALT may be a beneficial means of reducing the CRB rate in hemodialysis patients with UC Tunneled cuffed central vein catheters ( TCC ) are widely used for delivering hemodialysis ( HD ) . Infection is the principal cause of morbidity and mortality associated with central vein catheters in patients on HD . The optimal strategy to combat TCC infection is controversial . This prospect i ve study assesses the efficacy of antibiotic-lock therapy using vancomycin and gentamycin in preventing catheter-related blood stream bacterial infection in patients on HD . A total of 86 TCC in 69 HD patients were enrolled at the time of catheter insertion for delivering HD . Patients were r and omized into two groups : Group I ( 36 patients -39 insertions ) included TCC with antibiotic-lock therapy and Group II ( 33 patients -47 insertions ) with routine TCC management .  Infection-free catheter survival of both groups was evaluated and compared at the end of the 18-month study period . A total of 72 TCC infections were detected with an incidence rate of 6.78 infections/1000 dialysis sessions . The rate of infection was significantly lower in Group I ( 4.39/1000 dialysis sessions ) compared to Group II ( 11.69/1000 dialysis sessions ) , p<0.001 . The bacteremia rate , as well as rate of clinical sepsis were also significantly lower in Group I than in Group II ( p<0.001 ) . There was no statistically significant difference in the rate of access site infection in the two groups ( p>0.05 ) . Our study suggests that antibiotic-lock therapy using a combination of vancomycin and gentamycin is useful in preventing catheter-related blood stream infection in patients on HD BACKGROUND Formation of an intraluminal microbial biofilm is noted to play a significant role in the development of catheter-related infections ( CRIs ) . Recently , it has been demonstrated that trisodium citrate ( TSC ) has superior antimicrobial effects over heparin for catheter locking . In this r and omized controlled trial , we compared the influence of catheter locking with heparin and TSC on the in vivo intraluminal biofilm formation in haemodialysis catheters . METHODS Six patients were studied from the time of catheter insertion for haemodialysis treatment . They were r and omly assigned to TSC 30 % or heparin 5000 U/ml for catheter locking for the duration of 1 month . After elective guidewire exchange of the catheter , the locking solution was also changed . After removal , catheters were dissected in three segments and examined by st and ardized scanning electron microscopy ( SEM ) to assess quantitative biofilm formation . Furthermore , st and ardized cultures of all segments were performed to identify any microorganisms . RESULTS In catheters filled with TSC , the average coverage by biofilm was 16 % versus 63 % in the heparin group ( P < 0.001 ) . A total of eight subsegments were associated with local catheter infection in the patients who were r and omized to heparin locking versus three subsegments who were assigned to TSC ( P < 0.05 ) . CONCLUSIONS Our study demonstrates that using TSC 30 % for catheter locking reduces the formation of microbial biofilm in haemodialysis catheters and culture-positive colonization . It is likely that this is the explanation for the observed prevention of CRIs by TSC locking Background and Purpose : Catheter-related bloodstream infection is the greatest threat to the safety of patients on hemodialysis .  Catheter lock solutions containing heparin have been linked to an increased risk of hemorrhage and thrombocytopenia . Objectives : To ascertain the safety and efficacy for prevention of catheter-related bloodstream infection and catheter loss from patency failure of a novel catheter lock solution with antimicrobial and antithrombotic activity containing 0.24 M ( 7.0 % ) sodium citrate , 0.15 % methylene blue , 0.15 % methylparaben , and 0.015 % propylparaben ( C-MB-P ) , compared with heparin . Design : Multicenter , prospect i ve , r and omized , open-label trial with patients studied for up to 6 months . An independent clinical evaluation committee assessing trial outcomes was blinded to patients ' treatment assignments . Setting : Twenty-five outpatient hemodialysis units . Patients : Patients with end-stage renal disease receiving maintenance hemodialysis through a percutaneous cuffed and tunneled internal jugular hemodialysis catheters . Interventions : Participants 
    Output:
    
Antibiotic antimicrobial and combined ( antibiotic-non antibiotic ) lock solutions decreased the incidence of CRI compared to control lock solutions , whereas non-antibiotic lock solutions reduce CRI only for tunnelled CVC .
The effect on thrombosis incidence is uncertain for all antimicrobial lock solutions .