Antibiotic-Impregnated Central Venous Catheters for the Prevention of Catheter-Related Bloodstream Infection in Children: A Meta-Analysis

Abstract

Background: Use of central venous catheters (CVCs) ensure stable access in critically ill patients but is associated with increased infection rates. CVCs with antimicrobials has been recommended for infection reduction in adults. A review of antibiotic-impregnated CVCs' usefulness in children is needed. Objectives: To determine the effectiveness of antibiotic-impregnated CVCs in reducing infection in children Search Methods: Extensive search of MEDLINE, Cochrane Database of Systematic Reviews and Cochrane Register of Controlled Trials, Clinicaltrials.gov, Google scholar was done for trials published until June 2016. Reference lists from retrieved journals were checked for relevant articles. Selection Criteria: RCTs evaluating antibiotic-impregnated compared with standard CVCs for reducing infection in children. Data Collection and Analysis: Two authors assessed trial quality and extracted data. Statistical analysis was done using Review Manager with fixed or random effects model. Outcomes: bloodstream infection, hypersensitivity, thrombosis, mortality, site infection, length of ICU and hospital stay. Dichotomous data were presented as risk ratios (RR), continuous data as mean differences with 95% confidence intervals (CIs). Main Results: Two low quality trials (n=1773) were analyzed showing nonsignficant reduction of bloodstream infection in the antibiotic-impregnated group compared to standard catheters (RR 0.49; 95% CI 0.23-1.02,I2=0%) with no increased risk of thrombosis (RR 1.04 95% CI 0.84-1.28,I2=0%). No statistical difference was seen in the duration of ICU and hospital stay. Authors' Conclusions: There is no evidence that antibiotic-impregnated CVCs reduced bacteremia in children, increased the risk for thrombosis, or improved ICU and hospital stay. More RCTs are needed to determine benefits of antibiotic-impregnated CVCs.