Vascular access is the major risk factor for
bacteremia, hospitalization, and mortality among
hemodialysis (HD) patients. The type of vascular access most associated with
bloodstream infection is
central venous catheter (CVC). The incidence of
catheter-related
bacteremia ranges between 0.6 and 6.5 episodes per 1000
catheter days and increases linearly with the duration of
catheter use. Given the high prevalence of CVC use and its direct association with
catheter-related
bacteremia, which adversely impacts morbidity and mortality rates and costs among HD patients, several prevention measures aimed at reducing the rates of CVC-related
infections have been proposed and implemented. As a result, a large number of clinical trials, systematic reviews, and meta-analyses have been conducted in order to assess the effectiveness, clinical applicability, and
long-term adverse effects of such measures. In the following article, prophylactic measures against CVC-related
infections in HD patients and their possible advantages and limitations will be discussed, and the more recent literature on clinical experience with prophylactic antimicrobial lock
therapy in HD CVCs will be reviewed.