Veenstra D L, Saint S, Saha S, Lumley T, Sullivan S D
Department of Pharmacy, University of Washington, Seattle, USA.
JAMA. 1999 Jan 20;281(3):261-7. doi: 10.1001/jama.281.3.261.
Central venous catheters impregnated with chlorhexidine and silver sulfadiazine have recently been introduced for the prevention of catheter-related infections. However, there remains some uncertainty regarding the efficacy of these catheters because of conflicting reports in the literature.
To evaluate the efficacy of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in the prevention of catheter-related bloodstream infection.
Studies identified from a computerized search of the MEDLINE database from January 1966 to January 1998, reference lists of identified articles, and queries of principal investigators and the catheter manufacturer.
Randomized trials comparing chlorhexidine-silver sulfadiazine-impregnated central venous catheters with nonimpregnated catheters were included. The outcomes assessed were catheter colonization and catheter-related bloodstream infection confirmed by catheter culture.
Twelve studies met the inclusion criteria for catheter colonization and included a total of 2611 catheters. Eleven studies with a total of 2603 catheters met the inclusion criteria for catheter-related bloodstream infection. Most patients in these studies were from groups considered to be at high risk for catheter-related infections. Summary statistics were calculated using Mantel-Haenszel methods under a fixed-effects model.
The summary odds ratio for catheter colonization was 0.44 (95% confidence interval [CI], 0.36-0.54; P<.001), indicating a significant decrease in catheter colonization associated with impregnated catheters. The studies examining the outcome of primary interest, catheter-related bloodstream infection, had a summary odds ratio of 0.56 (95% CI, 0.37-0.84; P = .005).
Central venous catheters impregnated with a combination of chlorhexidine and silver sulfadiazine appear to be effective in reducing the incidence of both catheter colonization and catheter-related bloodstream infection in patients at high risk for catheter-related infections.
最近已引入含氯己定和磺胺嘧啶银的中心静脉导管来预防导管相关感染。然而，由于文献报道相互矛盾，这些导管的疗效仍存在一些不确定性。
评估含氯己定 - 磺胺嘧啶银的中心静脉导管在预防导管相关血流感染方面的疗效。
通过计算机检索1966年1月至1998年1月的MEDLINE数据库、已识别文章的参考文献列表以及向主要研究者和导管制造商咨询后识别出的研究。
纳入比较含氯己定 - 磺胺嘧啶银的中心静脉导管与未浸渍导管的随机试验。评估的结局是通过导管培养确认的导管定植和导管相关血流感染。
12项研究符合导管定植的纳入标准，共纳入2611根导管。11项共2603根导管的研究符合导管相关血流感染的纳入标准。这些研究中的大多数患者来自被认为导管相关感染高危的群体。使用固定效应模型下的Mantel - Haenszel方法计算汇总统计量。
导管定植的汇总比值比为0.44（95%置信区间[CI]，0.36 - 0.54；P <.001），表明浸渍导管相关的导管定植显著减少。研究主要关注的结局导管相关血流感染，其汇总比值比为0.56（95% CI，0.37 - 0.84；P = .005）。
含氯己定和磺胺嘧啶银组合的中心静脉导管似乎能有效降低导管相关感染高危患者的导管定植和导管相关血流感染的发生率。
