Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants

Balain, M; Oddie, Sam; McGuire, William

doi:10.1002/14651858.cd011078.pub2

Cited by 26 publications

(17 citation statements)

References 70 publications

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“…As 754 (88%) babies participating in the trial were born before 32 weeks of gestation, this trial provides important new evidence for a group at high risk of infection, who have frequent use of PICCs, but for whom trial evidence is lacking. 13,14 The pragmatic trial design, with no additional sampling, and use of a primary outcome on the basis of positive cultures taken as part of clinical practice in response to suspected infection to guide antibiotic treatment, ensured relevance to routine practice. Although blood culture is relatively insensitive, we found no difference in clinical outcomes such as duration of antibiotics or PICC insertion.…”

Section: Discussionmentioning

confidence: 99%

“…12 However, there are no recommendations for newborn babies because few antimicrobial-impregnated catheters are narrow enough for preterm babies and there is a paucity of evidence from adequately powered randomised trials. 13,14 The PREVAIL trial aimed to address this evidence gap by determining the effectiveness of an antimicrobial-impregnated CVC licensed for newborn infants. We compared use of a miconazole and rifampicin-impregnated CVC with a standard (nonimpregnated) CVC for reduction of bloodstream infection, morbidity, and mortality in newborn babies receiving intensive care.…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial

Gilbert

Brown

Rainford

et al. 2019

The Lancet Child & Adolescent Health

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Background Bloodstream infection is associated with high mortality and serious morbidity in preterm babies. Evidence from clinical trials shows that antimicrobial-impregnated central venous catheters (CVCs) reduce catheterrelated bloodstream infection in adults and children receiving intensive care, but there is a paucity of similar evidence for babies receiving neonatal intensive care. Methods This open-label, parallel-group, pragmatic, randomised controlled trial was done in 18 neonatal intensive care units in England. Newborn babies who needed a peripherally inserted CVC (PICC) were allocated randomly (1:1) to receive either a PICC impregnated with miconazole and rifampicin or a standard (non-antimicrobial-impregnated) PICC. Random allocation was done with a web-based program, which was centrally controlled to ensure allocation concealment. Randomisation sequences were computer-generated in random blocks of two and four, and stratified by site. Masking of clinicians to PICC allocation was impractical because rifampicin caused brown staining of the antimicrobial-impregnated PICC. However, participant inclusion in analyses and occurrence of outcome events were determined following an analysis plan that was specified before individuals saw the unblinded data. The primary outcome was the time from random allocation to first microbiologically confirmed bloodstream or cerebrospinal fluid (CSF) infection between 24 h after randomisation and 48 h after PICC removal or death. We analysed outcome data according to the intention-to-treat principle. We excluded babies for whom a PICC was not inserted from safety analyses, as these analyses were done with groups defined by the PICC used. This trial is registered with ISRCTN, number 81931394. Findings Between Aug 12, 2015, and Jan 11, 2017, we randomly assigned 861 babies (754 [88%] born before 32 weeks of gestation) to receive an antimicrobial-impregnated PICC (430 babies) or standard PICC (431 babies). The median time to PICC removal was 8•20 days (IQR 4•77-12•13) in the antimicrobial-impregnated PICC group versus 7•86 days (5•00-12•53) days in the standard PICC group (hazard ratio [HR] 1•03, 95% CI 0•89-1•18, p=0•73), with 46 (11%) of 430 babies versus 44 (10%) of 431 babies having a microbiologically confirmed bloodstream or CSF infection. The time from random allocation to first bloodstream or CSF infection was similar between the two groups (HR 1•11, 95% CI 0•73-1•67, p=0•63). Secondary outcomes relating to infection, rifampicin resistance in positive blood or CSF cultures, mortality, clinical outcomes at neonatal unit discharge, and time to PICC removal were similar between the two groups, although rifampicin resistance in positive cultures of PICC tips was higher in the antimicrobial-impregnated PICC group (relative risk 3•51, 95% CI 1•16-10•57, p=0•018). 60 adverse events were reported from 49 (13%) patients in the antimicrobial-impregnated PICC group and 50 events from 45 (10%) babies in the standard PICC group. Interpretation We found no evidence of benefit or ha...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial

Gilbert

Brown

Rainford

et al. 2019

The Lancet Child & Adolescent Health

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“…Another important small molecule is the organic compound cis-2-decenoic acid isolate from P. aeruginosa that can inhibit biofilm development by a number of bacteria, including E. coli, Klebsiella pneumoniae, Proteus mirabilis, Streptococcus pyogenes, Bacillus subtilis, S. aureus, and Candida albicans [18]. ( Figure 2) Another strategy to combat biofilms is by avoiding the adherence of bacteria to surfaces or medical devices by bactericidal/bacteriostatic coating [29]. In this sense, catheters and prosthesis are Another strategy to combat biofilms is by avoiding the adherence of bacteria to surfaces or medical devices by bactericidal/bacteriostatic coating [29].…”

Section: Prevention or Treatment Of Biofilm Infectionsmentioning

confidence: 99%

“…( Figure 2) Another strategy to combat biofilms is by avoiding the adherence of bacteria to surfaces or medical devices by bactericidal/bacteriostatic coating [29]. In this sense, catheters and prosthesis are Another strategy to combat biofilms is by avoiding the adherence of bacteria to surfaces or medical devices by bactericidal/bacteriostatic coating [29]. In this sense, catheters and prosthesis are coated with antibiotics or silver.…”

Section: Prevention or Treatment Of Biofilm Infectionsmentioning

confidence: 99%

The Usefulness of Microalgae Compounds for Preventing Biofilm Infections

López

Soto

2019

Antibiotics

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Biofilms play an important role in infectious diseases. It has been estimated that most medical infections are due to bacterial biofilms, and about 60–70% of nosocomial infections are also caused by the formation of a biofilm. Historically, microalgae are an important source of bioactive compounds, having novel structures and potential biological functions that make them attractive for different industries such as food, animal feed, aquaculture, cosmetics, and pharmaceutical. Several studies have described compounds produced by microalgae and cyanobacteria species with antimicrobial activity. However, studies on the antibiofilm activity of extracts and/or molecules produced by these microorganisms are scarce. Quorum-sensing inhibitor and anti-adherent agents have, among others, been isolated from microalgae and cyanobacteria species. The use of tools such as nanotechnology increase their power of action and can be used for preventing and treating biofilm-related infections.

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“…Minocycline is a tetracycline derivative that binds with the 30s ribosomal subunit, while rifampin is a semisynthetic derivative of rifamycin which inhibits bacterial RNA synthesis by blocking RNA transcription [4]. Minocycline and rifampin impregnated CVCs may reduce bacterial colonization; reduce micro-organism adhesion and survival, thus inhibiting intraluminal or extra-luminal biofilm formation [5].…”

Section: How the Intervention Might Workmentioning

confidence: 99%

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

Espino¹,

Dator²,

Gonzales³

2017

Microbiol Infect Dis

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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.

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Antimicrobial-impregnated central venous catheters for prevention of catheter-related bloodstream infection in newborn infants

Cited by 26 publications

References 70 publications

Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial

Antimicrobial-impregnated central venous catheters for prevention of neonatal bloodstream infection (PREVAIL): an open-label, parallel-group, pragmatic, randomised controlled trial

The Usefulness of Microalgae Compounds for Preventing Biofilm Infections

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

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