实施集束化干预措施的抗菌涂层中心静脉导管预防导管相关血流感染的有效性：一项系统评价和网状Meta分析
Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis.
作者信息
Wang Hongliang, Tong Hongshuang, Liu Haitao, Wang Yao, Wang Ruitao, Gao Hong, Yu Pulin, Lv Yanji, Chen Shuangshuang, Wang Guiyue, Liu Miao, Li Yuhang, Yu Kaijiang, Wang Changsong
机构信息
Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
出版信息
Ann Intensive Care. 2018 Jun 15;8(1):71. doi: 10.1186/s13613-018-0416-4.
BACKGROUND
Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under bundles could further reduce the incidence of CRBSIs is unclear. We aimed to assess the effectiveness of implementing the use of bundles with antimicrobial-coated CVCs for preventing catheter-related blood-stream infections.
METHODS
In this systematic review and network meta-analyses, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library in addition to the EMBASE, MEDLINE, CINAHL, and Web of Science databases for studies published before July 2017. The primary outcome was the rate of CRBSIs per 1000 catheter-days, and the secondary outcome was the incidence of catheter colonization.
RESULTS
Twenty-three studies revealed significant differences in the rate of CRBSIs per 1000 catheter-days between antimicrobial-impregnated and standard CVCs (RR 0.70, 95% CI 0.53-0.91, p = 0.008). Thirty-three trials were included containing 10,464 patients who received one of four types of CVCs. Compared with a standard catheter, chlorhexidine/silver sulfadiazine- and antibiotic-coated catheters were associated with lower numbers of CRBSIs per 1000 catheter-days (ORs and 95% CrIs: 0.64 (0.40-0.955) and 0.53 (0.25-0.95), respectively) and a lower incidence of catheter colonization (ORs and 95% CrIs: 0.44 (0.34-0.56) and 0.30 (0.20-0.46), respectively).
CONCLUSIONS
Outcomes are superior for catheters impregnated with chlorhexidine/silver sulfadiazine or other antibiotics than for standard catheters in preventing CRBSIs and catheter colonization under bundles. Compared with silver ion-impregnated CVCs, chlorhexidine/silver sulfadiazine antiseptic catheters resulted in fewer cases of microbial colonization of the catheter but did not reduce CRBSIs.
背景
导管相关血流感染（CRBSIs）是使用中心静脉导管（CVCs）时最常见的并发症。在集束化措施基础上对CVCs进行涂层处理是否能进一步降低CRBSIs的发生率尚不清楚。我们旨在评估实施使用带有抗菌涂层的CVCs集束化措施预防导管相关血流感染的有效性。
方法
在这项系统评价和网状荟萃分析中，除了EMBASE、MEDLINE、CINAHL和科学引文索引数据库外，我们还检索了Cochrane图书馆中的Cochrane对照试验中心注册库（CENTRAL），以查找2017年7月之前发表的研究。主要结局是每1000导管日的CRBSIs发生率，次要结局是导管定植的发生率。
结果
23项研究表明，抗菌浸渍CVCs与标准CVCs相比，每1000导管日的CRBSIs发生率存在显著差异（风险比0.70，95%置信区间0.53 - 0.91，p = 0.008）。纳入了33项试验，包含10464例接受四种类型CVCs之一的患者。与标准导管相比，洗必泰/磺胺嘧啶银涂层导管和抗生素涂层导管每1000导管日的CRBSIs数量较少（比值比和95%可信区间分别为：0.64（0.40 - 0.955）和0.53（0.25 - 0.95）），导管定植发生率也较低（比值比和95%可信区间分别为：0.44（0.34 - 0.56）和0.30（0.20 - 0.46））。
结论
在集束化措施下，洗必泰/磺胺嘧啶银或其他抗生素浸渍的导管在预防CRBSIs和导管定植方面的效果优于标准导管。与银离子浸渍CVCs相比，洗必泰/磺胺嘧啶银抗菌导管导致的导管微生物定植病例较少，但并未降低CRBSIs的发生率。
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