Abstract
Objective
This systematic review assesses the effect of anti-infective-treated central venous catheters (CVCs) on catheter-related bloodstream infection (CRBSI) in the acute care setting.
Methods
Randomized controlled trials were retrieved from Medline and the Cochrane Library up to 15 January 2007. Two reviewers independently assessed trial quality and extracted data. Data for CRBSI were combined where appropriate, using a random effects model. The impact of the risk for CRBSI in the control group (baseline risk) on the benefit of anti-infective CVCs was studied by using meta-regression based on the binomial normal bivariate meta-analysis model.
Results
Twenty-one trials were included in the review. Mainly intensive care (IC) patients were studied. Eighteen trials showed that anti-infective CVCs reduced the risk of CRBSI. The number needed to treat (NNT) varied from 182 to 12, with baseline risks ranging from 1% to 10%. Nearly all trials had serious methodological shortcomings. Three trials comparing minocycline-rifampicin-treated catheters with antiseptic-treated catheters showed inconsistent results. One trial suggested that there is not any difference in CRBSI between heparin- and antiseptic-treated CVCs.
Conclusion
Because the NNT is large when the baseline risk is low, the use of anti-infective-treated CVCs in the acute care setting should only be considered in situations in which background rates of CRBSI are high. The magnitude of benefit as calculated in this review should be interpreted with caution because of strong arguments in favor of a systematic overestimation of the effect. Which type of anti-infective catheter is most effective could not be established from the available data.
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References
National Nosocomial Infections Surveillance (2004) National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 32:470–485
Vincent JL, Bihari DJ, Suter PM, Bruining HA, White J, Nicolas-Chanoin MH, Wolff M, Spencer RC, Hemmer M (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee 274:639–644
Maki DG, Cobb L, Garman JK, Shapiro JM, Ringer M, Helgerson RB (1988) An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 85:307–314
Darouiche RO (2003) Nosocomial bloodstream infections and second generation vascular catheters. In: Wenzel RP (ed) Prevention and control of nosocomial infections. Lippincott Williams & Wilkins, Baltimore
Guidet B, Nicola I, Barakett V, Gabillet JM, Snoey E, Petit JC, Offenstadt G (1994) Skin versus hub cultures to predict colonization and infection of central venous catheter in intensive care patients. Infection 22:43–48
Salzman MB, Isenberg HD, Shapiro JF, Lipsitz PJ, Rubin LG (1993) A prospective study of the catheter hub as the portal of entry for microorganisms causing catheter-related sepsis in neonates. J Infect Dis 167:487–490
Salzman MB, Rubin LG (1997) Relevance of the catheter hub as a portal for microorganisms causing catheter-related bloodstream infections. Nutrition 13:15S–17S
Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD (1999) Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection, a meta-analysis. JAMA 281(3):261–267
Walder B, Pittet D, Tramer MR (2002) 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. Infect Control Hosp Epidemiol 23:748–756
Von Houwelingen HC, Arends LR, Stijnen T (2002) Advanced methods in meta-analysis: multivariate approach and meta-regression. Stat Med 21:589–624
Chu HT, Cole SR (2007) Bivariate meta-analysis of sensitivity and specificity with sparse data: a generalized linear mixed model approach. J Clin Epidemiol 59:1331–1332
Van Houwelingen HC, Zwinderman KH, Stijnen T (1993) A bivariate approach to meta-analysis. Stat Med 12:2273–2284
Boswald M, Lugauer S, Regenfus A, Braun GG, Martus P, Geis C, Scharf J, Bechert T, Greil J, Guggenbichler JP (1999) Reduced rates of catheter-associated infection by use of a new silver-impregnated central venous catheter. Infection [Suppl] 27(1):S56–S60
Darouiche RO, Berger DH, Khardori N, Robertson CS, Wall MJ Jr, Metzler MH, Shah S, Mansouri MD, Cerra-Stewart C, Versalovic J, Reardon MJ, Raad II (2005) Comparison of antimicrobial impregnation with tunneling of long-term central venous catheters: a randomized controlled trial. Ann Surg 242:193–200
Dunser MW, Mayr AJ, Hinterberger G, Florl CL, Ulmer H, Schmid S, Friesenecker B, Lorenz I, Hasibeder WR (2005) Central venous catheter colonization in critically ill patients: a prospective, randomized, controlled study comparing standard with two antiseptic-impregnated catheters. Anesth Analg 101:1778–1784
Goldschmidt H, Hahn U, Salwender HJ, Haas R, Jansen B, Wolbring P, Rinck M, Hunstein W (1995) Prevention of catheter-related infections by silver coated central venous catheters in oncological patients. Zentralbl Bakteriol 283:215–223
Schutze GE (2002) Antimicrobial-impregnated central venous catheters. Pediatr Infect Dis J 21:63–64
Khare MD, Bukhari SS, Swann A, Spiers P, McLaren I, Myers J (2007) Reduction of catheter-related colonisation by the use of a silver zeolite-impregnated central vascular catheter in adult critical care. J Infect 54:146–150
Krafte-Jacobs B, Sivit CJ, Mejia R, Pollack MM (1995) Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Pediatr 126:50–54
Loertzer H, Soukup J, Hamza A, Wicht A, Rettkowski O, Koch E, Fornara P (2006) Use of catheters with the AgION antimicrobial system in kidney transplant recipients to reduce infection risk. Transplant Proc 38:707–710
Long DA, Coulthard MG (2006) Effect of heparin-bonded central venous catheters on the incidence of catheter-related thrombosis and infection in children and adults. Anaesth Intensive Care 34:481–484
Loo S, van Heerden PV, Gollege CL, Roberts BL, Power BM (1997) Infection in central lines: antiseptic-impregnated vs standard non-impregnated catheters. Anaesth Intensive Care 25:637–639
Ranucci M, Isgro G, Giomarelli PP, Pavesi M, Luzzani A, Cattabriga I, Carli M, Giomi P, Compostella A, Digito A, Mangani V, Silvestri V, Mondelli E (2003) Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection. Crit Care Med 31:52–59
Richards B, Chaboyer W, Bladen T, Schluter PJ (2003) Effect of central venous catheter type on infections: a prospective clinical trial. J Hosp Infect 54:10–17
Stoiser B, Kofler J, Staudinger T, Georgopoulos A, Lugauer S, Guggenbichler JP, Burgmann H, Frass M (2002) Contamination of central venous catheters in immunocompromised patients: a comparison between two different types of central venous catheters. J Hosp Infect 50:202–206
Tennenberg S, Lieser M, McCurdy B, Boomer G, Howington E, Newman C, Wolf I (1997) A prospective randomized trial of an antibiotic- and antiseptic-coated central venous catheter in the prevention of catheter-related infections. Arch Surg 132:1348–1351
Theaker C, Juste R, Lucas N, Tallboys C, Azadian B, Soni N (2002) Comparison of bacterial colonization rates of antiseptic impregnated and pure polymer central venous catheters in the critically ill. J Hosp Infect 52:310–312
Van Heerden PV, Webb SA, Fong S, Golledge CL, Roberts BL, Thompson WR (1996) Central venous catheters revisited—infection rates and an assessment of the new Fibrin Analysing System brush. Anaesth Intensive Care 24:330–333
Chatzinikolaou I, Finkel K, Hanna H, Boktour M, Foringer J, Ho T, Raad I (2003) Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter-related infections: a prospective, randomized study. Am J Med 115:352–357
Leon C, Ruiz-Santana S, Rello J, de la Torre MV, Valles J, Alvarez-Lerma F, Sierra R, Saavedra P, Alvarez-Salgado F (2004) Benefits of minocycline and rifampin-impregnated central venous catheters. A prospective, randomized, double-blind, controlled, multicenter trial. Intensive Care Med 30:1891–1899
Marik PE, Abraham G, Careau P, Varon J, Fromm RE Jr (1999) The ex vivo antimicrobial activity and colonization rate of two antimicrobial-bonded central venous catheters. Crit Care Med 27:1128–1131
Raad I, Darouiche R, Dupuis J, Abi-Said D, Gabrielli A, Hachem R, Wall M, Harris R, Jones J, Buzaid A, Robertson C, Shenaq S, Curling P, Burke T, Ericsson C (1997) Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. The Texas Medical Center Catheter Study Group. Ann Intern Med 127:267–274
Yucel N, Lefering R, Maegele M, Max M, Rossaint R, Koch A, Schwarz R, Korenkov M, Beuth J, Bach A, Schierholz J, Pulverer G, Neugebauer EA (2004) Reduced colonization and infection with miconazole-rifampicin modified central venous catheters: a randomized controlled clinical trial. J Antimicrob Chemother 54:1109–1115
Bach A, Schmidt H, Bottiger B, Schreiber B, Bohrer H, Motsch J, Martin E, Sonntag HG (1996) Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J Antimicrob Chemother 37:315–322
Brun-Buisson C, Doyon F, Sollet JP, Cochard JF, Cohen Y, Nitenberg G (2004) Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled trial. Intensive Care Med 30:837–843
Collin GR (1999) Decreasing catheter colonization through the use of an antiseptic-impregnated catheter: a continuous quality improvement project. Chest 115:1632–1640
Corral L, Nolla-Salas M, Ibanez-Nolla J, Leon MA, Diaz RM, Cruz MM, Iglesia R, Catalan R (2003) A prospective, randomized study in critically ill patients using the Oligon Vantex catheter. J Hosp Infect 55:212–219
George SJ, Vuddamalay P, Boscoe MJ (1997) Antiseptic-impregnated central venous catheters reduce the incidence of bacterial colonization and associated infection in immunocompromised transplant patients. Eur J Anaesthesiol 14:428–431
Hannan M, Juste RN, Umasanker S, Glendenning A, Nightingale C, Azadian B, Soni N (1999) Antiseptic-bonded central venous catheters and bacterial colonisation. Anaesthesia 54:868–872
Heard SO, Wagle M, Vijayakumar E, McLean S, Brueggemann A, Napolitano LM, Edwards LP, O'Connell FM, Puyana JC, Doern GV (1998) Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med 158:81–87
Maki DG, Stolz SM, Wheeler S, Mermel LA (1997) Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 127:257–266
Moretti EW, Ofstead CL, Kristy RM, Wetzler HP (2005) Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia. J Hosp Infect 61:139–145
Osma S, Kahveci SF, Kaya FN, Akalin H, Ozakin C, Yilmaz E, Kutlay O (2006) Efficacy of antiseptic-impregnated catheters on catheter colonization and catheter-related bloodstream infections in patients in an intensive care unit. J Hosp Infect 62:156–162
Rupp ME, Lisco SJ, Lipsett PA, Perl TM, Keating K, Civetta JM, Mermel LA, Lee D, Dellinger EP, Donahoe M, Giles D, Pfaller MA, Maki DG, Sherertz R (2005) Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: a randomized, controlled trial. Ann Intern Med 143:570–580
Sheng WH, Ko WJ, Wang JT, Chang SC, Hsueh PR, Luh KT (2000) Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients. Diagn Microbiol Infect Dis 38:1–5
Pierce CM, Wade A, Mok Q (2000) Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med 26:967–972
Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, Berg J, Khardori N, Hanna H, Hachem R, Harris RL, Mayhall G (1999) A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med 340:1–8
Fraenkel D, Rickard C, Thomas P, Faoagali J, George N, Ware R (2006) A prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters. Crit Care Med 34:668–675
Carrasco MN, Bueno A, de las Cuevas C, Jimenez S, Salinas I, Sartorius A, Recio T, Generelo M, Ruiz-Ocana F (2004) Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients. Intensive Care Med 30:633–638
Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM (1996) CDC definitions for nosocomial infections. In: Olmsted RN (ed) APIC infection control and applied epidemiology: principles and practice. Mosby, St. Louis, pp A1–A20
Berenholtz SM, Pronovost PJ, Lipsett PA, Hobson D, Earsing K, Farley JE, Milanovich S, Garrett-Mayer E, Winters BD, Rubin HR, Dorman T, Perl TM (2004) Eliminating catheter-related bloodstream infections in the intensive care unit. Crit Care Med 32:2014–2020
O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA (2002) Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 23:759–769
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Niël-Weise, B.S., Stijnen, T. & van den Broek, P.J. Anti-infective-treated central venous catheters: a systematic review of randomized controlled trials. Intensive Care Med 33, 2058–2068 (2007). https://doi.org/10.1007/s00134-007-0897-3
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DOI: https://doi.org/10.1007/s00134-007-0897-3