Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy; Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica Del Sacro Cuore, Rome, Italy; Global Health Research Institute, Istituto di Igiene, Università Cattolica Del Sacro Cuore, Rome, Italy.
Institute of Pediatrics, Università Cattolica Del Sacro Cuore, Rome, Italy.
J Hosp Infect. 2022 Jul;125:1-20. doi: 10.1016/j.jhin.2022.03.010. Epub 2022 Apr 4.
Optimal management of central venous catheter-related, or -associated, bloodstream infections (CRBSI or CLABSI) in children is not established.
To evaluate success of catheter salvage strategies in paediatric patients.
Studies were retrieved from medical databases and article reference lists. Data were collected relating to clinical outcomes of two treatments: systemic antibiotics alone or in association with antimicrobial lock therapy (ALT). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from a mixed logistic effects model. Heterogeneity was summarized using I statistics. Publication bias was investigated by Egger's regression test and funnel plots.
From 345 identified publications, 19 met inclusion criteria (total of 914 attempted salvage strategies). To achieve successful catheter salvage, in CRBSI the addition of ALT was superior to systemic antibiotics alone (OR: -0.40; 95% CI: -1.41, 0.62): 77% (95% CI: 69, 85; I = 42.5%; P = 0.12) and 68% of success (95% CI: 59, 77; I = 0; P < 0.05), respectively. CRBSI recurrence was less common in studies that used ALT compared with systemic antibiotics alone: 5% (95% CI: 0, 13; I = 59.7%; P = 0.03) and 18% of recurrence (95% CI: 9, 28; I = 0; P < 0.05), respectively. Recurrences were low with both antibiotic locks and ethanol lock. No clear benefits of ALT addition compared to systemic antibiotic only were found in CLABSI (OR: -0.81; 95% CI: -0.80, 2.43).
The addition of an antimicrobial lock solution to systemic antibiotic may be beneficial for successful catheter salvage in paediatric patients with CRBSI, depending on aetiology, whereas no statistically significant difference between systemic antibiotic with or without addition of an antimicrobial lock solution was found regarding CLABSI.
儿童中心静脉导管相关或相关血流感染（CRBSI 或 CLABSI）的最佳治疗方法尚未确定。
评估儿科患者导管保留策略的成功率。
从医学数据库和文章参考文献列表中检索研究。收集了两种治疗方法的临床结果数据：单独使用全身抗生素或联合抗菌锁定治疗（ALT）。使用混合逻辑效应模型计算优势比（OR）和 95%置信区间（CI）。使用 I 统计量总结异质性。通过 Egger 回归检验和漏斗图调查发表偏倚。
从 345 篇已识别的出版物中，有 19 篇符合纳入标准（共 914 次尝试的保留策略）。为了实现成功的导管保留，在 CRBSI 中，添加 ALT 优于单独使用全身抗生素（OR：-0.40；95%CI：-1.41，0.62）：77%（95%CI：69，85；I=42.5%；P=0.12）和 68%的成功率（95%CI：59，77；I=0；P<0.05）。与单独使用全身抗生素相比，CRBSI 复发在使用 ALT 的研究中较少见：5%（95%CI：0，13；I=59.7%；P=0.03）和 18%的复发率（95%CI：9，28；I=0；P<0.05）。抗生素锁和乙醇锁的复发率均较低。在 CLABSI 中，与单独使用全身抗生素相比，添加抗菌锁的益处并不明显（OR：-0.81；95%CI：-0.80，2.43）。
根据病因，在儿童 CRBSI 患者中，全身性抗生素联合抗菌锁定溶液可能有利于成功保留导管，而在 CLABSI 中，全身性抗生素联合或不联合添加抗菌锁定溶液之间没有发现统计学上的显著差异。
