Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review

Abstract

Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention.Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials.Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5.Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects.

In vitro activity of antimicrobial‐impregnated catheters against biofilms formed by KPC‐producing Klebsiella pneumoniae

“…The authors informed that only studies conducted in intensive care units exhibited significant benefits. The statement is in contrast to another systematic review of RCTs and quasi-randomized clinical trials (Stocco et al 2016) that found no statistical differences between the use of impregnated and not-impregnated CVCs. The authors attested that further studies are needed to assess the mortality rates, adverse effects and presence of sepsis associated with second-generation CVC use.…”

“…CHX/SS‐impregnated catheters are commercially available and the literature reports that their durability and activity were 11 days (mean), with a reduced incidence of infection related to CVC installation (Stocco et al . ). Our results demonstrated that the CHX/SS combination lost its antibiofilm activity on day 15 of incubation against the tested strains.…”

“…According to Stocco et al . (), depending on the tested micro‐organism, there will be a short time to CVC colonization. Two in vitro studies of Jamal et al .…”

“…In another in vitro study, Raad et al (2012), reported a durability of less than 3 weeks for the CHX/SS-impregnated catheter against samples of Candida albicans and Pseudomonas aeruginosa. According to Stocco et al (2016), depending on the tested micro-organism, there will be a short time to CVC colonization. Two in vitro studies of Jamal et al (2014aJamal et al ( , 2014b informed that CHX/ SS-coated CVCs were not as effective in inhibiting biofilm colonization by several resistant Gram-negative and Gram-positive bacteria, including K. pneumoniae, as CHX/M-R (minocycline-rifampin).…”

Cirrhotic Liver of Liver Transplant Recipients Accumulate Silver and Co-Accumulate Copper

“…Silver is applied as a component of bone scaffolds due to the enhancement of their mechanical properties for bone tissue engineering applications [ 4 ]. Oral health could benefit from new generation of bioactive resins containing AgNPs [ 5 , 6 ]. In addition to their broad usage in dressings due to their biocidal properties, silver products indirectly reduce odor [ 7 ].…”