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

 

Bottom Line: Silver-coated central venous catheters may prevent CRBSIs in patients with haematological malignancy

 

Level of evidence: 1- (unblinded RCT with a high risk of bias) ? relevance to intensive care patients.

 

Citation: 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

Lead author's name:  Harter C

 

Three-part Clinical Question:

Patients: patients with haematological malignancy undergoing chemotherapy

Intervention: silver-coated or untreated catheters

Outcomes: catheter related bloodstream infection (CRBSI)

 

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

 

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

 

The Study Patients:  266 catheters in 266 patients

 

Control group (standard CVCs) n= 132 patients; 113 analysed

 

Experimental group (coated CVCs) n=134 patients; 120 analysed, 33 drop-outs occurred because of protocol violations

 

The Evidence:

 

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

At catheter removal

0.09

0.05

0.43

0.038

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, mainly because 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? No

 

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 was under-powered to detect clinically significant differences in infection rates. Although the patients had haematological malignancy, over half were in an ICU.

 

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 

 

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©SICS EBMG 2002