Lenz Ana M, Vassallo Juan C, Moreno Guillermo E, Althabe María, Gómez Silvia, Magliola Ricardo, Casimir Lidia, Bologna Rosa, Barretta Jorge, Ruffa Pablo
Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
Arch Argent Pediatr. 2010 Jun;108(3):209-15. doi: 10.1590/S0325-00752010000300006.
To evaluate the cost-effectiveness of the antiseptic-impregnated catheter compared with conventional catheters in preventing catheter- related blood stream infections (CR-BSI).
Cost-effectiveness analysis; clinical trial, experimental, randomized, controlled, prospective, open label. Patients and methods. A 172 patient cohort, under 1-year-old or less than 10 kg, postoperative cardiovascular children with central venous catheters (CVC) admitted to Cardiac Intensive Care Unit (UCI 35) at Hospital Nacional de Pediatría "Prof. Dr. Juan P. Garrahan", since September 2005 to December 2007. Demographic and CVC data were retrieved to compare: age, gender, weight, diagnosis, surgery, CVC days, costs and complications. Intervention. CVC Arrow, double-lumen, > 48 h of duration; intervention group: antiseptic-impregnated CVC vs. control group: CVC without antiseptics (conventional).
The incidence of CR-IE (CR-Infected Events: colonization, local infection and/or CRBSI; combined end point) was 27% for antiseptic- impregnated CVC vs. 31% for conventional catheters (p= 0.6) with similar accumulated incidence of CR- BSI: 2.8 vs. 3.3 per 1000 dayscatheter. We found no differences between groups, except in weight: median 4.0 kg (r 2-17) vs. 4.7 kg (r 2-9) p= 0.0002 and age, median 2 months (r 1- 48) vs. 5 months (r 1- 24) p= 0.0019 in antiseptic-impregnated CVC group. These differences, though statistically significant were clinically non relevant. Median cost per patient during intensive care stay in the conventional CVC group was $3.417 (359-9.453) and in the antiseptic-impregnated-CVC group was $4.962 (239-24.532), p= 0.10.
The use of antiseptic-impregnated CVC compared with conventional CVC did not decrease CR-BSI in this population. The cost per patients was higher in the antiseptic impregnated CVC group. These results do not support the routine use of this type of CVC in our population.
评估抗菌涂层导管与传统导管相比在预防导管相关血流感染（CR-BSI）方面的成本效益。
成本效益分析；临床试验，实验性、随机、对照、前瞻性、开放标签。患者与方法。自2005年9月至2007年12月，172例1岁以下或体重小于10kg的术后心血管疾病儿童患者，因中心静脉导管（CVC）入住国立儿科学会“胡安·P·加拉汉教授博士”医院心脏重症监护病房（UCI 35）。收集人口统计学和CVC数据以进行比较：年龄、性别、体重、诊断、手术、CVC留置天数、成本和并发症。干预措施。CVC Arrow双腔，留置时间>48小时；干预组：抗菌涂层CVC，对照组：无抗菌剂的CVC（传统导管）。
抗菌涂层CVC的CR-IE（CR感染事件：定植、局部感染和/或CRBSI；联合终点）发生率为27%，传统导管为31%（p = 0.6），CR-BSI的累积发生率相似：每1000天导管日分别为2.8和3.3。除体重外，两组间无差异：抗菌涂层CVC组中位数为4.0kg（范围2-17），传统导管组为4.7kg（范围2-9），p = 0.0002；年龄方面，抗菌涂层CVC组中位数为两个月（范围1-48），传统导管组为5个月（范围1-24），p = 0.0019。这些差异虽然具有统计学意义，但在临床上无关紧要。传统CVC组重症监护期间每位患者的中位数成本为3417美元（359-9453美元），抗菌涂层CVC组为4962美元（239-24532美元），p = 0.10。
与传统CVC相比，使用抗菌涂层CVC并未降低该人群的CR-BSI。抗菌涂层CVC组每位患者的成本更高。这些结果不支持在我们的人群中常规使用此类CVC。
