Antimicrobial central venous catheters in adults: a systematic review and meta-analysis

• Published in: The Lancet infectious diseases Vol. 8; no. 12; pp. 763 - 776
• Main Authors: Casey, Anna L, PhD, Mermel, Leonard A, Prof, Nightingale, Peter, PhD, Elliott, Tom SJ, Prof
• Format: Journal Article
• Language: English
• Published: London Elsevier Ltd 01.12.2008; Lancet Publishing Group; Elsevier Limited
• Subjects: Adult; Anti-Infective Agents, Local - administration & dosage; Antibacterial agents; Antibiotics. Antiinfectious agents. Antiparasitic agents; Bacteremia - prevention & control; Biological and medical sciences; Catheterization, Central Venous - adverse effects; General aspects; Human infectious diseases. Experimental studies and models; Humans; Infectious Disease; Infectious diseases; Medical sciences; Pharmacology. Drug treatments; Silver Sulfadiazine - administration & dosage; Human; Prevention; Nosocomial infection; Antibiotic; Impregnated material; Catheter; Adult; Antibacterial agent; Antimicrobial agent; Bibliographic review; Central vein
• ISSN: 1473-3099; 1474-4457
• DOI: 10.1016/S1473-3099(08)70280-9

Summary Several antimicrobial central venous catheters (CVCs) are available. We did a meta-analysis to assess their efficacy in reducing microbial colonisation and preventing catheter-related bloodstream infection (CRBSI). An extensive literature search of articles in any language was undertaken. We assessed randomised clinical trials in which available antimicrobial CVCs were compared with either a standard CVC or another antimicrobial CVC. Outcomes assessed were microbial colonisation of CVCs and CRBSI. The first-generation chlorhexidine–silver sulfadiazine (CSS) CVCs reduce colonisation (odds ratio [OR] 0·51 [95% CI 0·42–0·61]) and CRBSI (OR 0·68 [0·47–0·98]), as do the minocycline–rifampicin CVCs (OR 0·39 [0·27–0·55] and OR 0·29 [0·16–0·52], respectively). The minocycline–rifampicin CVCs outperformed the first-generation CSS CVCs in reducing colonisation (OR 0·34 [0·23–0·49]) and CRBSI (OR 0·18 [0·07–0·51]). Many shortcomings in methodological quality limit our interpretation of the study results. However, the available evidence suggests that use of CSS and minocycline–rifampicin CVCs are useful if the incidence of CRBSI is above institutional goals despite full implementation of infection prevention interventions.