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Do antibiotic impregnated central lines prevent catheter-related bloodstream infection?

 

The Bottom Line: Antibiotic-impregnated catheters reduce catheter colonisation but not catheter-related bloodstream infection

 

Level of evidence: 1- (under-powered RCT with a high risk of bias)

 

Citation: 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

 

Lead author's name: Carrasco MN

 

Three-part Clinical Question:

Patients: intensive care patients.

Intervention: antiseptic-coated (silver sulphadiazine and chlorhexidine) CVCs vs  heparin-coated CVCs.

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

 

Search Terms: intensive care, critical care, central venous catheters, infection, prevention, controlled trial

The Study: Randomised, controlled trial without intention-to treat analysis

 

The Study Patients: 276 catheters inserted into 196 patients.


Control group: n=132 heparin-coated catheters; 7 not cultured
 

Experimental group n=128; chlorhexidine & silver sulphadiazine-coated catheters. 9 not cultured

 

The Evidence:

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

At catheter removal

0.03

0.023

0.23

0.007

NS

95% Confidence Intervals:

NS

NS

NS

 

EBM questions:

 

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 study

 

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? A

 

11) Should I change my practice because of these results? Perhaps- it depends on your views about the validity and importance of pooled analysis of RCTs.

 

12) Should I audit my current practice because of these results? No, but you should be auditing CRBSI rates anyway.

 

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

 

Email: d.g.swann@ad.ac.uk

 

June 2005

 

Kill by Date: 2010

 

Edited by CC

 

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©SICS EBM 2005