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Do silver iontophoretic central lines prevent catheter-related bloodstream infection?

 

The Bottom Line: Silver iontophoretic central venous catheters did not prevent CRBSIs in a small study. 

 

Level of evidence: 1- (under-powered; sample included non-ICU patients)

 

Citation: Bong JJ, et al. Prevention of catheter related bloodstream infection by silver iontophoretic central venous catheters: a randomised controlled trial. J Clin Pathol 2003; 56:731–735

 

Lead author's name: Bong JJ

 

Three-part Clinical Question:

Patients: ‘high-risk’ patients, most needing TPN

Intervention: silver inotophoretic or untreated catheters

Outcomes: catheter colonisation and catheter related bloodstream infection (CRBSI)

 

Search Terms: central venous catheters, infection

The Study: Randomised, unblinded controlled trial with intention-to treat analysis

 

The Study Patients: 304 catheters inserted into 268 patients


Control group n= 161; 140 analysed. Untreated CVCs


Experimental group n=143; 128 analysed (Drop-outs occurred because catheters were not cultured). Silver inotophoretic treated CVCs.

 

The Evidence:

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

At catheter removal

 0.079

0.055

0.3

0.024

NS

95% Confidence Intervals:

NS

NS

NS

 

EBM Comments:

 

1) Do the methods allow accurate testing of the hypothesis? No, the study was underpowered.

 

2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? No, the study was underpowered.

 

3) Are conclusions valid in light of the results? Yes

 

4) Did results get omitted, and why? Yes, some catheters were not cultured on removal

 

5) Did they suggest areas of further research? Yes, a larger RCT

 

6) Did they make any recommendations based on the results and were they appropriate?

No

 

7) Is the study relevant to my clinical practice? Yes

 

8) What level of evidence does this study represent? 1-

 

9) What grade of recommendation can I make on this result alone? N/A

 

10) What grade of recommendation can I make when this study is considered along with other available evidence? B

 

11) Should I change my practice because of these results? No

 

12) Should I audit my current practice because of these results? No

 

Comments

This study ended prematurely because of a difficulty with the supply of these catheters. Another manufacturer now supplies these CVCs. Because the antimicrobial action lasts for the duration of catheter use, a larger RCT would be welcomed.

 

Appraised by Dr Davis Swann, Consultant, ICU, Royal Infirmary of Edinburgh.

 

June 2005

 

Kill by Date: 2010

 

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