Ji Ruoyu, He Zhangyuting, Zhou Jiawei, Fang Shiyuan, Ge Lili
Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Department of Haematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Front Pediatr. 2024 Jan 8;11:1324242. doi: 10.3389/fped.2023.1324242. eCollection 2023.
Post-catheter removal sepsis (PCRS) is a notable complication of indwelling central venous catheters (CVCs) in neonates, which is postulated to be secondary to the disruption of biofilms formed along catheter tips up on CVCs removal. It remains controversial whether this could be prevented by antibiotic use upon CVCs removal. We aimed to evaluate the protective effect of antibiotic administration at the time of CVCs removal.
We searched through PubMed, EMBASE, Cochrane databases and reference lists of review articles for studies comparing the use of antibiotics versus no use within 12 h of CVCs removal. Risk of bias was assessed using the modified Newcastle-Ottawa Scale and Cochrane risk-of-bias tool accordingly. Results of quantitative analyses were presented as mean differences (MD) or odds ratio (OR). Subgroup and univariate meta-regression analyses were performed to identify heterogeneity.
The review included 470 CVCs in the antibiotic group and 658 in the control group. Antibiotic use within 12 h of CVCs removal did not significantly reduce the incidence of PCRS (OR = 0.35, 95% CI: 0.08-1.53), but was associated with a lower incidence of post-catheter removal blood stream infection (OR = 0.31, 95% CI: 0.11-0.86). Dosage of vancomycin and world region were major sources of heterogeneity.
Antibiotic administration upon CVCs removal does not significantly reduce the incidence of PCRS but offers less post-catheter removal blood stream infection. Whether this will be converted to better clinical outcomes lacks evidential support. Further randomized controlled studies with longer follow-up are needed.
Results of our meta-analysis suggest that antibiotic use at planned central line removal removal does not significantly reduce the incidence of PCRS but offers less blood stream infection, which might contribute to future management of central lines in neonates.
https://www.crd.york.ac.uk/, PROSPERO (CRD42022359677).
拔管后脓毒症（PCRS）是新生儿留置中心静脉导管（CVC）的一种显著并发症，据推测是由于拔除CVC时导管尖端形成的生物膜被破坏所致。拔除CVC时使用抗生素能否预防这种情况仍存在争议。我们旨在评估拔除CVC时使用抗生素的保护作用。
我们检索了PubMed、EMBASE、Cochrane数据库以及综述文章的参考文献列表，以查找比较拔除CVC后12小时内使用抗生素与不使用抗生素的研究。使用改良的纽卡斯尔-渥太华量表和Cochrane偏倚风险工具评估偏倚风险。定量分析结果以平均差（MD）或比值比（OR）表示。进行亚组分析和单变量Meta回归分析以识别异质性。
该综述纳入了抗生素组的470根CVC和对照组的658根CVC。拔除CVC后12小时内使用抗生素并未显著降低PCRS的发生率（OR = 0.35，95%CI：0.08 - 1.53），但与较低的拔管后血流感染发生率相关（OR = 0.31，95%CI：0.11 - 0.86）。万古霉素剂量和世界区域是异质性的主要来源。
拔除CVC时使用抗生素并不能显著降低PCRS的发生率，但能减少拔管后血流感染的发生。这是否会转化为更好的临床结局缺乏证据支持。需要进行更长随访期的进一步随机对照研究。
我们的Meta分析结果表明，计划拔除中心静脉导管时使用抗生素并不能显著降低PCRS的发生率，但能减少血流感染，这可能有助于未来新生儿中心静脉导管的管理。
