Department of Anaesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan.
Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Centre, Saitama, Japan; Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Centre, Tokyo, Japan.
J Hosp Infect. 2021 Apr;110:156-164. doi: 10.1016/j.jhin.2021.01.017. Epub 2021 Jan 30.
The most effective skin antiseptic solution to reduce the incidence of catheter-related bloodstream infections (CRBSI) remains unknown.
To compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter, and identify an association with the incidence of CRBSI.
This study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients aged ≥18 years with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multi-variate random effects meta-analysis, and the effect size was expressed as relative risk (RR) with 95% confidence interval (CI).
The search yielded 1511 records, of which five studies (2815 catheters) were included in the network meta-analysis. The risk of CRBSI was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (RR 0.40, 95% CI 0.16-0.98; high certainty) or 10% PVI-aqueous (RR 0.31, 95% CI 0.15-0.63; high certainty). There was no significant difference in the risk of CRBSI between 1% CHG-alcohol and 2% CHG-aqueous (RR 0.35, 95% CI 0.12-1.04; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI was 1% CHG-alcohol, 0.5% CHG-alcohol, 2% CHG-aqueous and 10% PVI-aqueous.
Antiseptic agents containing 1% CHG-alcohol were more strongly associated with reduced risk for CRBSI compared with agents containing 0.5% CHG-alcohol or 10% PVI-aqueous.
为降低导管相关血流感染（CRBSI）的发生率，最有效的皮肤消毒剂仍不明确。
比较不同浓度洗必泰（CHG）和聚维酮碘（PVI）溶液在中心静脉导管（CVC）或动脉导管成人患者中的效果，明确与 CRBSI 发生率的相关性。
本研究评估了比较年龄≥18 岁、患有基础疾病且存在 CVC 或动脉导管患者使用 CHG 和 PVI 消毒剂的随机对照试验。主要结局为 CRBSI 发生率。采用基于贝叶斯方法的频繁性检验多变量随机效应荟萃分析，以相对危险度（RR）和 95%置信区间（CI）表示效应大小。
搜索共得到 1511 条记录，其中 5 项研究（2815 个导管）纳入网状荟萃分析。与 0.5% CHG-酒精（RR 0.40，95%CI 0.16-0.98；高确定性）或 10% PVI-水溶液（RR 0.31，95%CI 0.15-0.63；高确定性）相比，1% CHG-酒精的 CRBSI 风险显著降低。1% CHG-酒精与 2% CHG-水溶液（RR 0.35，95%CI 0.12-1.04；中等确定性）或其他消毒剂溶液之间，CRBSI 风险无显著差异。降低 CRBSI 的疗效等级为 1% CHG-酒精、0.5% CHG-酒精、2% CHG-水溶液和 10% PVI-水溶液。
与含有 0.5% CHG-酒精或 10% PVI-水溶液的消毒剂相比，含 1% CHG-酒精的消毒剂与降低 CRBSI 风险的相关性更强。
