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

 

Bottom Line: Antibiotic CVCs did not reduce CRBSIs in a small study

 

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

 

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

Lead author's name: Yucel, N

 

Three-part Clinical Question:

Patients: hospital in- patients

Intervention: antimicrobial impregnation with miconazole & rifampicin or untreated central venous catheters

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

 

Search Terms: randomized controlled trials, CVCs, prevention, bloodstream infections, antimicrobial agents

 

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

 

The Study Patients: 260 patients
 

Control group (standard CVC) n= 134; 105 analysed
 

Experimental group (impregnated CVC) n=126; 118 analysed

 

The Evidence:

 

Outcome

Time to Outcome

CER

EER

RRR

ARR

NNT

CRBSI

At catheter removal

0.01

0

1

0.01

NS

95% Confidence Intervals:

 

NS

NS

 

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? No, the study was only powered to detect differences in catheter colonisation, not CRBSIs

 

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? No

 

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, the sample was from a hospital population, rather than the intensive care population. These catheters are unavailable

 

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? No

 

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 

 

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

 

Edited by CC 

Kill by Date: 2010 

 

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