Comparative Efficacy of Antimicrobial Central Venous Catheters in Reducing Catheter-Related Bloodstream Infections in Adults: Abridged Cochrane Systematic Review and Network Meta-Analysis

Chong, Huey Yi; Lai, Nai Ming; Apisarnthanarak, Anucha; Chaiyakunapruk, Nathorn

doi:10.1093/cid/cix019

Cited by 44 publications

(39 citation statements)

References 103 publications

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“…Rifampicin is more active against Grampositive than against Gram-negative bacteria and has synergistic action against staphylococci when combined with another antibacterial drug-eg, minocyclineespecially against methicillin-resistant strains. 17,23 Second, although the combination of minocycline and rifampicin has been reported as the most effective type of antimicrobial impregnation in systematic reviews, 24,25 it is possible that minocycline and rifampicinimpregnated CVCs might not effectively reduce overall incidence of bloodstream infection or sepsis. 26 A network meta-analysis of seven randomised trials in adults showed beneficial effects of antimicrobial impregnation for catheter-related blood stream infection, 25 but few trials have measured the effect on any bloodstream infection.…”

Section: Discussionmentioning

confidence: 99%

“…17,23 Second, although the combination of minocycline and rifampicin has been reported as the most effective type of antimicrobial impregnation in systematic reviews, 24,25 it is possible that minocycline and rifampicinimpregnated CVCs might not effectively reduce overall incidence of bloodstream infection or sepsis. 26 A network meta-analysis of seven randomised trials in adults showed beneficial effects of antimicrobial impregnation for catheter-related blood stream infection, 25 but few trials have measured the effect on any bloodstream infection. 10 Catheter-related infection requires the same isolates from blood and CVC tip and could be prone to bias because of inhibition of positive tip cultures by leaching of antimicrobial from the tip during plating out for culture.…”

Section: Discussionmentioning

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: Discussionmentioning

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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“…In other studies with coated catheters inconsistent data is reported. While some did not reveal any differences in catheter colonization for different catheter types either, others observed beneficial effects of different coatings in reducing colonization [9][10][11][12]14,[20][21][22] .…”

Section: Discussionmentioning

confidence: 92%

“…However, these catheters have some disadvantages, e.g. limited time of drug release, risk of toxic or anaphylactic reactions, and discussed risk of bacterial resistance against antibiotics 5,9,13,14 . Therefore it is recommended to limit their use to intensive care 4 .…”

Section: Introductionmentioning

confidence: 99%

The efficacy of a non-leaching antibacterial central venous catheter - a prospective, randomized, double-blind study

et al. 2020

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Background. Antimicrobial coatings of central venous catheters (CVC) have the potential to reduce the risk of infectious complications. The aim of this study was to examine the efficacy of a catheter with a non-leaching antimicrobial coating against catheter colonization and bloodstream infections (BSI). Methods. The study was conducted in two centers using a prospective, randomized, double-blind and controlled design (680 intensive care patients; a protective CVC (Certofix® protect) or a standard CVC (Certofix®). Primary objectives were the rates of catheter colonization and BSI in the two groups. Other baseline demographics, APACHE II score, insertion site, location of CVC placement (ICU or theatre), indwelling time and length of ICU stay were comparable for both groups. Results. While the rate of catheter colonization between the coated and uncoated CVC (17.4% vs. 18.7%, P=0.7477) and the rate of microbiologically confirmed catheter associated infections were similar (1.4% vs. 1.9%, P=0.7521), the coated CVC showed a significantly lower incidence of BSI (2.0% vs. 6.5%, P=0.0081) and a significantly lower mean incidence of BSI per 1000 catheter days (3.2 vs. 8.3, P=0.0356). Conclusion. The non-leaching antibacterial coating of the protective catheter was effective in reducing the incidence of BSI but not the rate of catheter colonization. However, the incidence of BSI is a better surrogate marker for the risk of developing clinical signs of infection suggesting that use of the non-leaching protective catheter is effective in this regard. Trial number: ClinicalTrials.gov (ID: NCT00555282), https://clinicaltrials.gov/show/NCT00555282

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“…Additional strategies to prevent CLABSI focus on maintenance of the necessary CVC. These include daily CHG bathing to reduce the bacterial load on the skin and daily patient hygiene [12,16]; disinfection of catheter hubs prior to access, needleless connectors, and injection ports; dressing changes with CHG-impregnated dressings every 5-7 days or sooner if visibly soiled, wet, or loose; use of antibiotic-impregnated catheters; and use of ethanol-impregnated disinfection caps [17][18][19][20][21][22].…”

Section: Central Line-associated Bloodstream Infectionsmentioning

confidence: 99%

Hospital Epidemiology and Infection Control in the Transplant Center

Patel¹,

Hochman²

2020

Emerging Transplant Infections

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Both solid organ and hematopoietic stem cell transplant candidates and recipients are at high risk for healthcare-associated infections due to their underlying diseases, comorbid conditions, as well as the receipt of augmented immunosuppression to prevent rejection. Partnership between transplant physicians, institutional leaders, and infection preventionists allows for the accommodation of this growing vulnerable patient population into institutional risk assessments and hazard analyses. In addition, advancements in diagnostics and molecular typing have provided important information regarding sources of transmission of multidrug-resistant or opportunistic pathogens, thus informing strategies for mitigating risk and controlling outbreaks. Here we review common healthcare-associated infections and strategies for source control, prevention, and curbing outbreaks when detected.

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Comparative Efficacy of Antimicrobial Central Venous Catheters in Reducing Catheter-Related Bloodstream Infections in Adults: Abridged Cochrane Systematic Review and Network Meta-Analysis

Cited by 44 publications

References 103 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 efficacy of a non-leaching antibacterial central venous catheter - a prospective, randomized, double-blind study

Hospital Epidemiology and Infection Control in the Transplant Center

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