Comparative efficacy of 13 antimicrobial dressings and different securement devices in reducing catheter-related bloodstream infections

Abstract

Purpose: The purpose of our study is to carry out a Bayesian network meta-analysis comparing the efficacy of different antimicrobial dressings for prevention of catheter-related blood infections (CRBSI) and rank these antimicrobial dressings for practical consideration. Methods: We searched the PubMed, Cochrane library, Embase, earlier relevant meta-analysis and reference lists of included studies for randomized controlled trials (RCTs) that compared dressings for prevention of CRBSI. Two authors independently extracted data from each included RCT according to a predesigned Excel spreadsheet and assessed the methodological quality of included RCTs using the Cochrane risk of bias tool. Data was analyzed using the WinBUGS (V.1.4.3) and the Stata (V.15.0). Results: Finally, 35 RCTs involving 8494 patients and evaluating 13 dressings were included. Network meta-analysis showed that transparent dressing may be the best way to prevent CRBSI. Suture and bordered polyurethane dressing might have the lowest risk of CRBSI rate per 1000 catheter-days, and sutureless securement device might lead to the lowest incidence of catheter failure. Conclusions: This network meta-analysis indicated that transparent dressings may be selected for the prevention of CRBSI in patients with central venous catheters, which is of importance in future research. Although evidence is scant, more attention should be paid to head-to-head comparisons of the most commonly used dressings in this field.

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…Randomized trials and meta-analyses have shown no difference in risk of CRIs between single- or multiple-lumen CVC, and therefore, a preferred use of single-lumen catheters is not supported [ 151 – 153 ]. The use of sutureless devices was found to reduce the risk of CRI in a randomized study and in two meta-analyses accounting for multiple treatments [ 141 , 142 , 154 ].…”

“…CVC gauze dressings should be replaced every 2 days, transparent dressings once weekly, unless there are signs of local contamination, inflammation, or detachment [1,25,27,140]. Whether the use of gauze or transparent dressings is preferable in terms of lower CRI rates was addressed in two recent meta-analyses [141,142]. Dang and colleagues reported that transparent dressings were associated with a lower risk of CRBSI [142].…”

“…Whether the use of gauze or transparent dressings is preferable in terms of lower CRI rates was addressed in two recent meta-analyses [141,142]. Dang and colleagues reported that transparent dressings were associated with a lower risk of CRBSI [142]. In contrast, an analysis of 22 studies did not find sufficient evidence for a difference in the rate of CRBSI between different non- impregnated dressings [141].…”

Carbapenems vs tigecycline for the treatment of complicated intra-abdominal infections

“…To rank the treatments for each outcome, we used the surface under the cumulative ranking curve (SUCRA) and the mean ranks, SUCRA would be 100% when a treatment is certain to be the best and 0 when a treatment is certain to be the worst, and higher posterior probabilities in each simulation indicates the higher chance of being the best treatment regimen. [29,30]…”

Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses

“…In the absence of a positive blood culture, blind adjudication of the diagnosis of CAI is important to prevent differential detection bias. Of note, only six of 35 RCTs comparing antimicrobial dressings had a blind outcome assessment [96].…”