Vernon-Roberts Angharad, Lopez Robert N, Frampton Christopher M, Day Andrew S
Department of Paediatrics, Department of Medicine, University of Otago, Christchurch, New Zealand.
Starship Children's Hospital, Auckland, New Zealand.
JPEN J Parenter Enteral Nutr. 2022 Sep;46(7):1535-1552. doi: 10.1002/jpen.2363. Epub 2022 Mar 25.
Parenteral nutrition administered via central venous catheter is an established treatment option for people with intestinal failure. A serious complication of central venous catheters is the high risk of catheter-related bloodstream infections (CRBSIs). Catheter-locking solutions are one strategy for CRBSI prevention, with the solution taurolidine showing beneficial effects. The aim of this meta-analysis was to identify and synthesize evidence to assess taurolidine efficacy against comparators for the prevention of CRBSI for people with intestinal failure receiving parenteral nutrition.
Six health literature databases were searched for efficacy data of rate of CRBSI for taurolidine vs control among our study population; no study design limits were applied. Individual study data were presented for the number of CRBSIs and catheter days, and rate ratio. Overall data were synthesized as a pooled risk ratio, with subgroup analyses by study design, control type, and taurolidine solution.
Thirty-four studies were included in the final analysis. At the individual level, all studies showed superior efficacy of taurolidine vs control for prevention of CRBSIs. When the data were synthesized, the pooled risk ratio was 0.49 (95% CI, 0.46-0.53; P ≤ 0.0001), indicating a 51% decreased risk of CRBSI through the use of taurolidine. Subgroup analysis showed no difference depending on study design (P = 0.23) or control type (P = 0.37) and a significant difference for taurolidine type (P = 0.0005).
Taurolidine showed superior efficacy over controls regardless of study design or comparator group. The results show that taurolidine provides effective CRBSI reduction for people with intestinal failure receiving parenteral nutrition.
通过中心静脉导管给予肠外营养是治疗肠衰竭患者的一种既定治疗选择。中心静脉导管的一个严重并发症是导管相关血流感染（CRBSI）的高风险。导管封管溶液是预防CRBSI的一种策略，牛磺罗定溶液已显示出有益效果。本荟萃分析的目的是识别和综合证据，以评估牛磺罗定与对照相比对接受肠外营养的肠衰竭患者预防CRBSI的疗效。
检索六个健康文献数据库，以获取我们研究人群中牛磺罗定与对照的CRBSI发生率的疗效数据；未应用研究设计限制。呈现了个体研究数据，包括CRBSI的数量、导管使用天数和率比。总体数据合成为合并风险比，并按研究设计、对照类型和牛磺罗定溶液进行亚组分析。
最终分析纳入了34项研究。在个体水平上，所有研究均显示牛磺罗定在预防CRBSI方面比对照具有更高的疗效。当数据进行综合时，合并风险比为0.49（95%CI，0.46 - 0.53；P≤0.0001），表明使用牛磺罗定可使CRBSI风险降低51%。亚组分析显示，根据研究设计（P = 0.23）或对照类型（P = 0.37）无差异，而牛磺罗定类型有显著差异（P = 0.0005）。
无论研究设计或比较组如何，牛磺罗定均显示出比对照更高的疗效。结果表明，牛磺罗定可为接受肠外营养的肠衰竭患者有效降低CRBSI。
