School of Pharmacy, Monash University Malaysia.
School of Medicine, Taylor's University Lakeside Campus, Malaysia.
Clin Infect Dis. 2017 May 15;64(suppl_2):S131-S140. doi: 10.1093/cid/cix019.
The efficacy of antimicrobial central venous catheters (CVCs) remains questionable. In this network meta-analysis, we aimed to assess the comparative efficacy of antimicrobial CVC impregnations in reducing catheter-related infections in adults.
We searched 4 electronic databases (Medline, the Cochrane Central Register of Controlled Trials, Embase, CINAHL) and internet sources for randomized controlled trials, ongoing clinical trials, and unpublished studies up to August 2016. Studies that assessed CVCs with antimicrobial impregnation with nonimpregnated catheters or catheters with another impregnation were included. Primary outcomes were clinically diagnosed sepsis, catheter-related bloodstream infection (CRBSI), and all-cause mortality. We performed a network meta-analysis to estimate risk ratio (RR) with 95% confidence interval (CI).
Sixty studies with 17255 catheters were included. The effects of 14 impregnations were investigated. Both CRBSI and catheter colonization were the most commonly evaluated outcomes. Silver-impregnated CVCs significantly reduced clinically diagnosed sepsis compared with silver-impregnated cuffs (RR, 0.54 [95% CI, .29-.99]). When compared to no impregnation, significant CRBSI reduction was associated with minocycline-rifampicin (RR, 0.29 [95% CI, .16-.52]) and silver (RR, 0.57 [95% CI, .38-.86]) impregnations. No impregnations significantly reduced all-cause mortality. For catheter colonization, significant decreases were shown by miconazole-rifampicin (RR, 0.14 [95% CI, .05-.36]), 5-fluorouracil (RR, 0.34 [95% CI, .14-.82]), and chlorhexidine-silver sulfadiazine (RR, 0.60 [95% CI, .50-.72]) impregnations compared with no impregnation. None of the studies evaluated antibiotic/antiseptic resistance as the outcome.
Current evidence suggests that the minocycline-rifampicin-impregnated CVC appears to be the most effective in preventing CRBSI. However, its overall benefits in reducing clinical sepsis and mortality remain uncertain. Surveillance for antibiotic resistance attributed to the routine use of antimicrobial-impregnated CVCs should be emphasized in future trials.
抗菌中央静脉导管（CVC）的疗效仍存在疑问。在这项网络荟萃分析中，我们旨在评估在减少成人导管相关性感染方面，抗菌 CVC 浸渍的比较疗效。
我们检索了 4 个电子数据库（Medline、Cochrane 对照试验中心注册库、Embase、CINAHL）和互联网资源，以获取截至 2016 年 8 月的随机对照试验、正在进行的临床试验和未发表的研究。研究纳入了使用抗菌浸渍的 CVC 与非浸渍导管或其他浸渍导管的比较。主要结局为临床诊断的败血症、导管相关性血流感染（CRBSI）和全因死亡率。我们进行了网络荟萃分析以估计风险比（RR）及其 95%置信区间（CI）。
纳入了 60 项研究，共计 17255 根导管。研究了 14 种浸渍的效果。银浸渍 CVC 与银浸渍袖口相比，显著降低了临床诊断的败血症（RR，0.54[95%CI，0.29-0.99]）。与无浸渍相比，米诺环素-利福平（RR，0.29[95%CI，0.16-0.52]）和银（RR，0.57[95%CI，0.38-0.86]）浸渍显著降低了 CRBSI。无浸渍显著降低了全因死亡率。对于导管定植，米康唑-利福平（RR，0.14[95%CI，0.05-0.36]）、5-氟尿嘧啶（RR，0.34[95%CI，0.14-0.82]）和洗必泰-磺胺嘧啶银（RR，0.60[95%CI，0.50-0.72]）浸渍与无浸渍相比，显著降低了导管定植率。没有研究将抗生素/抗药性作为结局进行评估。
目前的证据表明，米诺环素-利福平浸渍的 CVC 似乎在预防 CRBSI 方面最有效。然而，其在降低临床败血症和死亡率方面的总体获益仍不确定。在未来的试验中，应强调对抗菌浸渍 CVC 常规使用引起的抗生素耐药性进行监测。
