Antimicrobial dressings for the prevention of catheter-related infections in newborn infants with central venous catheters

Abstract

Based on moderate-quality evidence, chlorhexidine dressing/alcohol skin cleansing reduced catheter colonisation, but made no significant difference in major outcomes like sepsis and CRBSI compared to polyurethane dressing/povidone-iodine cleansing. Chlorhexidine dressing/alcohol cleansing posed a substantial risk of contact dermatitis in preterm infants, although it was unclear whether this was contributed mainly by the dressing material or the cleansing agent. While silver-alginate patch appeared safe, evidence is still insufficient for a recommendation in practice. Future research that evaluates antimicrobial dressing should ensure blinding of caregivers and outcome assessors and ensure that all participants receive the same co-interventions, such as the skin cleansing agent. Major outcomes like sepsis, CRBSI and mortality should be assessed in infants of different gestation and birth weight.

Chlorhexidine gluconate or polyhexamethylene biguanide disc dressing to reduce the incidence of central-line-associated bloodstream infection: a feasibility randomized controlled trial (the CLABSI trial)

“…22 Consequently, chlorhexidine products have been not approved for use in children under two months of age for some years. 23 It is difficult to understand these disparate results, unless infant's skin responds differently to polyurethane than the skin of the older and quite unwell patients recruited to our trial.…”

Vancomycin-lock therapy for prevention of catheter-related bloodstream infection in very low body weight infants

“…Inclusion criteria of preterm infants were: 1) patients' birth weight ≤ 1.8 kg, and required total or partial parenteral nutrition (TPN or PPN), 2) patients received routine retention of PICC line for more than 2 weeks, and 3) patients were not systemically administrated antibiotics during the catheter lock. Patients who: 1) died during the rst week after birth or died of non-CRBSI reasons, 2) received routine retention of PICC line for less than 2 weeks, 3) were administrated with antibiotics during the catheter lock, 4) required umbilical venous catheters, 5) were transferred to other hospitals or departments or failed to complete a clinical observation for at least two weeks, or 6) with congenital immunode ciency, multiple malformations or congenital hypoglycemia, were excluded. The study was approved by the Ethics Committee of Guangzhou Women and Children's Medical Center (No.…”

“…Peripherally inserted central catheters (PICCs) are currently commonly used in neonatal intensive care units (NICUs), especially for the treatment of extremely preterm infants and very low birth weight (VLBW) infants. However, usage of PICCs increases the risk of nosocomial infection, documented as catheterrelated bloodstream infection (CRBSI) [1][2][3], which results in extended hospital stay and various lifethreatening complications such as necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP), leading to a mortality rate of 4-29% [4,5]. It is vital important to take preventive measures to reduce the incidence of CRBSI.…”

Vancomycin-lock therapy for prevention of catheter-related bloodstream infection in very low body weight infants 

“…Inclusion criteria of preterm infants were: 1) patients' birth weight ≤1.8 kg, and required total or partial parenteral nutrition (TPN or PPN), 2) patients received routine retention of PICC line for more than 2 weeks, and 3) patients were not systemically administrated antibiotics during the catheter lock. Patients who: 1) died during the rst week after birth or died of non-CRBSI reasons, 2) received routine retention of PICC line for less than 2 weeks, 3) were administrated with antibiotics before the catheter lock, 4) required umbilical venous catheters, 5) were transferred to other hospitals or departments or failed to complete a clinical observation for at least two weeks, or 6) with congenital immunode ciency, multiple malformations or congenital hypoglycemia, were excluded. The study was approved by the Ethics Committee of Guangzhou Women and Children's Medical Center (No.…”