Amsterdam School of Health Professions, Hogeschool van Amsterdam, University of Applied Sciences, 1000 BA Amsterdam, The Netherlands.
J Hosp Infect. 2010 May;75(1):1-11. doi: 10.1016/j.jhin.2009.12.017. Epub 2010 Mar 15.
Catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity. This systematic review assesses the efficacy of antibiotic-based lock solutions to prevent CRBSI. A secondary goal of our review is to determine which antibiotic-based lock solution is most effective in reducing CRBSI. We searched Medline and the Cochrane Library for relevant trials up to April 2009. Data from the original publications were used to calculate the overall relative risk of CRBSI. Data for similar outcomes were combined in the analysis where appropriate, using a random-effects model. Sixteen trials were included in the review, nine conducted in haemodialysis patients, six in oncology patients (mainly children) and one study concerned critically ill neonates. Three haemodialysis patients needed to be treated with antibiotics to prevent one CRBSI, given a mean insertion time of 146 days (range: 37-365) and an average baseline risk of 3.0 events per 1000 catheter-days. In the oncology patients a number needed to treat (NNT) was calculated of eight patients to prevent one BSI, given a mean insertion time of 227 days (range: 154-295) and average baseline risk of 1.7 events per 1000 catheter-days. There are indications that antibiotic-based lock solutions as compared to heparin lock solutions are effective in the prevention of CRBSI in haemodialysis patients. In trials studying oncology patients the estimated effect showed only a marginal significant benefit in favour of antibiotic-based lock solutions. Our review supports the Centers for Disease Control and Prevention in not recommending routine use of antibiotic-based catheter lock solutions.
导管相关性血流感染（CRBSI）与高发病率相关。本系统评价评估了抗生素封管液预防 CRBSI 的疗效。本研究的次要目标是确定哪种抗生素封管液在降低 CRBSI 方面最有效。我们检索了 Medline 和 Cochrane 图书馆，查找截至 2009 年 4 月的相关试验。原始出版物的数据用于计算 CRBSI 的总体相对风险。在适当的情况下，使用随机效应模型对类似结局的数据进行合并分析。本研究共纳入 16 项试验，其中 9 项在血液透析患者中进行，6 项在肿瘤患者（主要是儿童）中进行，1 项研究涉及危重新生儿。在血液透析患者中，平均插入时间为 146 天（范围：37-365 天），基线风险平均为每 1000 个导管日发生 3.0 次 CRBSI，因此每 3 个血液透析患者需要用抗生素治疗以预防 1 例 CRBSI。在肿瘤患者中，平均插入时间为 227 天（范围：154-295 天），基线风险平均为每 1000 个导管日发生 1.7 次 CRBSI，因此每 8 例患者需要用抗生素治疗以预防 1 例血流感染。有迹象表明，与肝素封管液相比，抗生素封管液在预防血液透析患者 CRBSI 方面更有效。在研究肿瘤患者的试验中，估计的效果仅显示抗生素封管液具有边际显著优势。本研究支持美国疾病控制与预防中心不推荐常规使用抗生素封管液。
