The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation

Abstract

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Are Early Cannulation Arteriovenous Grafts (ecAVG) a Viable Alternative to Tunnelled Central venous Catheters (TCVCs)? An Observational “Virtual Study” and Budget Impact Analysis

“…Median (15) time from referral to actual AVF procedure was 79 days and 57 days thereafter for AVF maturation (until first successful cannulation). Seven patients (8.8%) died during the follow-up period and were removed from the analysis at the time of their death.…”

What is new for the prevention of catheter-related bloodstream infections?

“…Veenstra et al published in 1999 a meta-analysis, which included 11 RCTs and 2,603 catheters, reporting that catheters impregnated with CHSS on the external surface (first generation) reduced the risk of CRBSI compared with non-impregnated catheters (28). Later, a meta-analysis published in 2008 by Hockenhull et al, including 3 RCTs and 1,176 patients, reported that catheters impregnated in CHSS on external and internal surfaces (second generation) reduced the CRBSI incidence compared to standard catheters (29). In addition, in a meta-analysis by Falagas et al published in 2007, including 3,452 CVCs from 8 RCTs (using rifampicin-minocycline impregnated catheters in 7 RCTs and rifampicin-miconazole impregnated catheters in 1 RCT), was found a reduction of CRBSI with the use of antimicrobial impregnated catheters compared with non-coated catheters (30).…”

“…In addition, in a meta-analysis by Falagas et al published in 2007, including 3,452 CVCs from 8 RCTs (using rifampicin-minocycline impregnated catheters in 7 RCTs and rifampicin-miconazole impregnated catheters in 1 RCT), was found a reduction of CRBSI with the use of antimicrobial impregnated catheters compared with non-coated catheters (30). Besides, the use of antimicrobial impregnated catheters has been found to reduce the catheter related cost in some cost-effectiveness analyses (29,31,32). However, in all those cost-effectiveness analyses was included the cost associated with the increase of hospital stay.…”

Bacteriophage K for reduction ofStaphylococcus aureusbiofilm on central venous catheter material

“…[1][2][3] Approximately 250000 cases of intravascular catheter-related bloodstream infections occur in the United States each year, resulting in a mortality of between 12-25% with an estimated cost of treatment per episode of approximately $25000. [3][4][5][6][7][8][9][10] The standard management of catheter-related infection involves decisions regarding removal of the catheter and the administration of appropriate antibiotics. Catheter removal and eventual replacement, raises important practical problems in these patients requiring parenteral nutrition, chemotherapy, and hemodialysis, among others.…”

“…It is widely believed that the high rate of therapy failure is explained in part by the inability of most antibiotics to kill bacteria growing in a biofilm. 3,6,[9][10][11][12][13][14][15] Certain infections now thought to be associated with biofilms, including otitis media, urinary tract infections, periodontitis, and burn infections, have been effectively treated with phage therapy. [16][17][18] Phage therapy has also been proposed to be used against multidrug-resistant bacteria, and may reduce the use of antimicrobial drugs and the spread of antimicrobial resistance.…”