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Prevention of Bloodstream Infections With Central Venous Catheters Treated With Anti-Infective Agents Depends on Catheter Type and Insertion Time: Evidence From a Meta-Analysis

Published online by Cambridge University Press:  02 January 2015

Bernhard Walder ,
Didier Pittet  and
Martin R. Tramèr
Bernhard Walder*
Affiliation:
Division of Surgical Intensive Care, University of Geneva Hospitals, Geneva, Switzerland
Didier Pittet
Affiliation:
Infection Control Program, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
Martin R. Tramèr
Affiliation:
Division of Anaesthesiology, Department APSIC, University of Geneva Hospitals, Geneva, Switzerland
*
Division of Surgical Intensive Care, University of Geneva Hospitals, 24 rue Micheli-du-Crest, CH-1211 Geneva 14, Switzerland
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Abstract

Objective:

To test the evidence that the risk of infection related to central venous catheters (CVCs) is decreased by anti-infective coating or cuffing.

Design:

Systematic review of randomized, controlled trials comparing anti-infective with inactive (control) CVCs.

Interventions:

Average insertion times were taken as a measurement of the length of insertion. Dichotomous data were combined using a fixed effect model and expressed as odds ratio (OR) with 95% confidence interval (CI95).

Results:

Two trials on antibiotic coating (343 CVCs) had an average insertion time of 6 days; the risk of BSI decreased from 5.1% with control to 0% with anti-infective catheters. There were no trials with longer average insertion times. In three trials on silver collagen cuffs (422 CVCs), the average insertion time ranged from 5 to 8.2 days (median, 7 days); the risk of BSI was 5.6% with control and 3.2% with anti-infective catheters. In another trial on silver collagen cuffs (101 CVCs), the average insertion time was 38 days; the risk of BSI was 3.7% with control and 4.3% with anti-infective catheters. In five trials on chlorhexidine-silver sulfadiazine coating (1,269 CVCs), the average insertion time ranged from 5.2 to 7.5 days (median, 6 days); the risk of BSI decreased from 4.1% with control to 1.9% with anti-infective catheters. In five additional trials on chlorhexidine–silver sulfadiazine coating (1,544 CVCs), the average insertion time ranged from 7.8 to 20 days (median, 12 days); the risk of BSI was 4.5% with control and 4.2% with anti-infective catheters.

Conclusions:

Antibiotic and chlorhexidine–silver sulfadiazine coatings are anti-infective for short (approximately 1 week) insertion times. For longer insertion times, there are no data on antibiotic coating, and there is evidence of lack of effect for chlorhexidine-silver sulfadiazine coating. For silver-impregnated collagen cuffs, there is evidence of lack of effect for both short- and long-term insertion.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 12 , December 2002 , pp. 748 - 756
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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