Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0b013e3181958915
Review Articles

The clinical effectiveness of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections: A systematic review*

Hockenhull, Juliet C. MSc; Dwan, Kerry M. MSc; Smith, Godfrey W. MD; Gamble, Carrol L. PhD; Boland, Angela PhD; Walley, Tom J. MD; Dickson, Rumona C. MHSc

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Objectives: To assess the clinical effectiveness of central venous catheters (CVCs) treated with anti-infective agents (AI-CVCs) in preventing catheter-related bloodstream infections (CRBSI).

Data Sources: MEDLINE (OVID), EMBASE, SCI//Web of Science, SCI/ISI Proceedings, and the Cochrane Library.

Study Selection: A systematic review of the literature was conducted using internationally recognized methodology. All included articles were reports of randomized controlled trials comparing the clinical effectiveness of CVCs treated with AI-CVCs with either standard CVCs or another anti-infective treated catheter. Articles requiring in-house preparation of catheters or that only reported interim data were excluded.

Data Extraction: Data extraction was carried out independently and crosschecked by two reviewers using a pretested data extraction form.

Data Synthesis: Meta-analyses were conducted to assess the effectiveness of AI-CVCs in preventing CRBSI, compared with standard CVCs. Results are presented in forest plots with 95% confidence intervals.

Results: Thirty-eight randomized controlled trials met the inclusion criteria. Methodologic quality was generally poor. Meta-analyses of data from 27 trials assessing CRBSI showed a strong treatment effect in favor of AI-CVCs (odds ratio 0.49 (95% confidence interval 0.37–0.64) fixed effects, test for heterogeneity, chi-square = 28.78, df = 26, p = 0.321, I2 = 9.7). Results subgrouped by the different types of anti-infective treatments generally demonstrated treatment effects favoring the treated catheters. Sensitivity analyses investigating the effects of methodologic differences showed no differences to the overall conclusions of the primary analysis.

Conclusion: AI-CVCs appear to be effective in reducing CRBSI compared with standard CVCs. However, it is important to establish whether this effect remains in settings where infection-prevention bundles of care are established as routine practice. This review does not address this question and further research is required.

© 2009 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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