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© SICS EBM Group 2004
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Are antiseptic or antibiotic-impregnated central lines better at preventing catheter-related bloodstream infection?
Citation: A comparison of two antimicrobial-impregnated central venous catheters.
Lead author's name: Dairoiuche RO
Three-part Clinical Question: Patients: hospital patients requiring triple-lumen catheters for >3 days, at high risk of infection. Intervention: antiseptic impregnation with silver sulphadiazine and chlorhexidine or antibiotic impregnation with minocycline and rifampin in central venous catheters. Outcomes: catheter colonisation and catheter related bloodstream infection (CRBSI).
Search Terms: Central venous catheters, Minocycline and rifampin-impregnated catheters, Bloodstream infection, Infectious complications
The Study: Randomised, unblinded controlled trial with intention-to treat analysis
The Study Patients: 865 catheters
The Evidence:
EBM questions:
1) Do the methods allow accurate testing of the hypothesis? Yes.
2) Do the statistical tests correctly test the results to allow differentiation of statistically significant results? Yes, the authors used data from previous studies to calculate that 724 patients were needed to detect a significant difference in infection rates between the two groups.
3) Are conclusions valid in light of the results? Yes
4) Did results get omitted, and why? Yes, 127 catheters were not cultured on removal
5) Did they suggest areas of further research? No
6) Did they make any recommendations based on the results and were they appropriate? Yes. “Despite their proven efficacy, antimicrobial-impregnated catheters should complement rather than replace adequate aseptic practices”
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? B
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? Perhaps, though many have reasonable, but unproven concerns about the emergence of antibiotic-resistant organisms with the use of these catheters. Antibiotic catheters are unavailable in the UK.
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
Edited by CC
June 2005
Kill by Date: 2010
©SICS EBM 2005
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