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Do antimicrobial central venous catheters prevent catheter-related blood stream infection in intensive care patients?

David Swann, on behalf of the SICS EBM group 

Author address:  Royal Infirmary of Edinburgh

Correspondence: d.g.swann@ed.ac.uk

Citation: EBM Reviews. Scottish Intensive Care Society EBM Group. D Swann. Do antimicrobial central venous catheters prevent catheter-related blood stream infection in intensive care patients? 2005

Background: Microbial colonization of CVCs is common. About 5% of central venous catheters cause a blood stream infection. This is associated with morbidity, mortality and costs. There have been many RCTs looking at the effectiveness of antimicrobial catheters at preventing CRBSI.

Objectives: Critical analysis of each relevant RCT and a pooled analysis of   RCTs of each catheter type.

Search strategy: Medline and Pubmed; search terms: intensive care, critical care, central venous catheters, infection, prevention, controlled trial, systematic review, meta-analysis. Back-chaining of relevant papers.

Selection criteria: Randomized, Controlled Trials. One was excluded from the pooled analysis because of unconventional definition of CRBSI.

Data collection and analysis:

The experimental and control group sizes were noted for each study. These excluded episodes of central venous catheterization that had been withdrawn from analysis because of the difficulty in determining to which group all ‘drop-outs’ belonged. Experimental and control events of CRBSI were noted. The results RCTs for each catheter type were pooled and analyzed.

Main results:

All patients in RCTs of antiseptic catheters (Ref 1,3,5,6,8,9,11,12,14,15,16,18,19,20):

Control group n= 1997
Experimental group n= 2021

The pooled evidence:

Intensive care patients in RCTs of antiseptic catheters (Ref: 1,3,6,8,9,11,15,19)
 

Control group n= 1039
Experimental group n= 1072

The pooled evidence:

All patients in RCTs of antibiotic catheters:

Control group n= 478
Experimental group n= 476

The pooled evidence:

Intensive care patients in RCTs of silver-impregnated catheters:

Control group n= 253
Experimental group n= 248

The pooled evidence:

Reviewers’ conclusions: Most RCTs were under-powered to answer this question. A pooled analysis of these RCTs suggests antiseptic and antibiotic CVCs prevent CRBSIs. However we have not fully considered the heterogeneity of these trials. Heterogeneity exists in the samples of patients, the diagnostic technique and the unit of analysis (catheter episode or patient).

 Areas of further research: 

•     Formal meta-analysis of these RCTs.

•     Large RCTs of antiseptic, antibiotic and silver-impregnated CVCs v. standard CVCs, sufficiently powered to detect  clinically significant difference in CRBSI rates.

 Citations with links to CATs: 

1. Bach A, et al. Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. Journal of Antimicrobial Chemotherapy, 1996; 37: 315-322. CAT.

2. 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. CAT.

3. Bruin-Buisson C, et al. Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled trial. Intensive Care Med 2004; 30:837–843. CAT.

4. Carrasco MN, et al. Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients. Intensive Care Medicine 2004, 30:633-8. CAT.

5. Ciresi DL, et al. Failure of antiseptic bonding to prevent central venous catheter-related infection and sepsis. American Surgeon 1996; 62: 641-7. CAT.

6. Collin GR, et al. Decreasing catheter colonization through the use of an antiseptic-impregnated catheter. Chest 1999; 115, 6: 1632-40. CAT.

7. Dairoiuche RO, et al. A comparison of two antimicrobial-impregnated central venous catheters. New Eng J Med, 1999; 340: 1-8. CAT.

8. George SJ, et al. Antiseptic-impregnated central venous catheters reduce the incidence of bacterial colonization and associated infection in immunocompromised transplant patients.European Journal of Anaesthesiology 1997; 14: 428-31. CAT.

9. Hannan M, et al. Antiseptic-bonded central venous catheters and bacterial colonisation Anaesthesia, 1999; 54: 868-872. CAT.

10. Harter C, et al. Catheter-related infection and thrombosis of the internal jugular vein in hematologic-oncologic patients undergoing chemotherapy: a prospective comparison of silver-coated and uncoated catheters. Cancer. 94(1):245-51, 2002 Jan 1. CAT.

11. Heard SO, et al. Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter related bacteraemia. Arch Intern Med, 1998; 158: 81-87. CAT.

12. Jaeger K, et al. Reduction of catheter-related infections in neutropenic patients: a prospective controlled randomized trial using a chlorhexidine and silver sulfadiazine-impregnated central venous catheter Ann Hematol., 2005;  84: 258–262. CAT.

13. Leon C, et al. Benefits of minocycline and rifampin-impregnated central venous catheters A prospective, randomized, double-blind, controlled, multicenter trial. Intensive Care Medicine, 2004; 30: 1891-99. CAT.

14. Logghe C, et al. Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial. Journal of Hospital Infection 1997; 37: 145-156. CAT.

15. Maki D, et al. Prevention of Central Venous Catheter-related Bloodstream Infection by Use of an Antiseptic-Impregnated Catheter. Ann Intern Med 1997; 127: 257-266. CAT.

16. Pemberton LB, et al. No difference in catheter sepsis between standard and antiseptic central venous catheters. A prospective randomized trial. Archives of Surgery 1996; 131: 986-9. CAT.

17. Raad I, et al. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. Ann Intern Med 1997; 127: 267-274. CAT.

18. Ramsay J, et al. Incidence of catheter colonization and catheter related infection with an antiseptic impregnated triple lumen catheter. Crit Care Med 1994; 22:A115. CAT.

19. Sheng W-H, et al. Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients. Diagnostic Microbiology and Infectious Disease, 2000; 38: 1-5. CAT.

20. Tennenberg S, et al. A Prospective Randomized Trial of an Antibiotic- and Antiseptic-Coated Central Venous Catheter in the Prevention of Catheter-Related Infections. Archives of Surgery 1997; 132: 1348-1351. CAT.

21. Yuecel N, et al. Reduced colonization and infection with miconazole – rifampicin modified central venous catheters: a randomized controlled clinical. Journal of Antimicrobial Chemotherapy, 2004; 54: 1109–1115. CAT.

     

    

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