Raad, 1997

Web site designed and maintained by Chris Cairns © SICS EBM Group 2004

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

Bottom Line: Antibiotic-impregnated catheters CRBSIs in hospital patients reduce CRBSIs

Level of evidence: 1⁺ (RCT with a low risk of bias)

Citation: 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

Lead author's name: Raad I

Three-part Clinical Question:

Patients: hospital patients requiring triple-lumen CVCs

Intervention: antibiotic impregnation minocycline and rifampin or untreated 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, double-blind controlled trial with intention-to treat analysis

The Study Patients: 298 catheters in 281 patients

Control group (standard CVC) n= 237; 180 analysed

Experimental group (impregnated CVC) n=228; 187 analysed

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

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

4) Did results get omitted, and why? Yes, 32 catheters were not cultured

5) Did they suggest areas of further research? Yes, additional RCTs of antibiotic CVCs for short and long term use

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

Yes, antibiotic impregnated catheters reduce the incidence of CRBSI. Yes.

7) Is the study relevant to my clinical practice? No, these catheters are unavailable in the UK

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? Probably not

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. June 2005

Edited by CC

Kill by Date: 2010