Patient Safety Enhancement Program, Hospital Outcomes Program of Excellence and Center for Clinical Management Research, Ann Arbor Veterans Affairs Medical Center and University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
Infect Control Hosp Epidemiol. 2013 Sep;34(9):908-18. doi: 10.1086/671737. Epub 2013 Jul 26.
Peripherally inserted central catheters (PICCs) are associated with central line-associated bloodstream infection (CLABSI). The magnitude of this risk relative to central venous catheters (CVCs) is unknown.
To compare risk of CLABSI between PICCs and CVCs.
MEDLINE, CinAHL, Scopus, EmBASE, and Cochrane CENTRAL were searched. Full-text studies comparing the risk of CLABSI between PICCs and CVCs were included. Studies involving adults 18 years of age or older who underwent insertion of a PICC or a CVC and reported CLABSI were included in our analysis. Studies were evaluated using the Downs and Black scale for risk of bias. Random effects meta-analyses were used to generate summary estimates of CLABSI risk in patients with PICCs versus CVCs.
Of 1,185 studies identified, 23 studies involving 57,250 patients met eligibility criteria. Twenty of 23 eligible studies reported the total number of CLABSI episodes in patients with PICCs and CVCs. Pooled meta-analyses of these studies revealed that PICCs were associated with a lower risk of CLABSI than were CVCs (relative risk [RR], 0.62; 95% confidence interval [CI], 0.40-0.94). Statistical heterogeneity prompted subgroup analysis, which demonstrated that CLABSI reduction was greatest in outpatients (RR [95% CI], 0.22 [0.18-0.27]) compared with hospitalized patients who received PICCs (RR [95% CI], 0.73 [0.54-0.98]). Thirteen of the included 23 studies reported CLABSI per catheter-day. Within these studies, PICC-related CLABSI occurred as frequently as CLABSI from CVCs (incidence rate ratio [95% CI], 0.91 [0.46-1.79]).
Only 1 randomized trial met inclusion criteria. CLABSI definition and infection prevention strategies were variably reported. Few studies reported infections by catheter-days.
Although PICCs are associated with a lower risk of CLABSI than CVCs in outpatients, hospitalized patients may be just as likely to experience CLABSI with PICCs as with CVCs. Consideration of risks and benefits before PICC use in inpatient settings is warranted.
外周置入中心静脉导管（PICC）与中心静脉相关血流感染（CLABSI）有关。其与中心静脉导管（CVC）相关的风险程度尚不清楚。
比较 PICC 和 CVC 发生 CLABSI 的风险。
检索 MEDLINE、CinAHL、Scopus、EmBASE 和 Cochrane CENTRAL。纳入比较 PICC 和 CVC 发生 CLABSI 风险的全文研究。纳入分析的研究对象为接受 PICC 或 CVC 置管且报告 CLABSI 的年龄 18 岁及以上的成年人。使用 Downs 和 Black 量表评估研究的偏倚风险。采用随机效应荟萃分析生成 PICC 与 CVC 患者 CLABSI 风险的综合估计值。
在 1185 项研究中，有 23 项研究纳入 57250 名患者符合入选标准。23 项合格研究中有 20 项报告了 PICC 和 CVC 患者 CLABSI 发作的总例数。对这些研究的汇总分析显示，与 CVC 相比，PICC 发生 CLABSI 的风险较低（相对风险 [RR]，0.62；95%置信区间 [CI]，0.40-0.94）。鉴于存在统计学异质性，故进行了亚组分析，结果显示门诊患者 CLABSI 减少幅度最大（RR [95%CI]，0.22 [0.18-0.27]），而接受 PICC 的住院患者则较小（RR [95%CI]，0.73 [0.54-0.98]）。纳入的 23 项研究中有 13 项报告了每根导管的 CLABSI 发生率。在这些研究中，PICC 相关性 CLABSI 的发生率与 CVC 相关性 CLABSI 相同（发病率比 [95%CI]，0.91 [0.46-1.79]）。
仅 1 项随机试验符合纳入标准。CLABSI 定义和感染预防策略的报告存在差异。很少有研究报告以导管日计算的感染。
虽然与 CVC 相比，PICC 在外周静脉置管患者中与 CLABSI 的相关性较低，但住院患者接受 PICC 治疗时发生 CLABSI 的可能性与 CVC 相当。在住院环境中使用 PICC 前应考虑其风险和获益。
