title: Prevention of bloodstream infections with central venous catheters treated with anti-infective agents depends on catheter type and insertion time: evidence from a meta-analysis.
abstract: OBJECTIVE
  To test the evidence that the risk of infection related to central venous catheters (CVCs) is decreased by anti-infective coating or cuffing.
  
  
  METHODS
  Systematic review of randomized, controlled trials comparing anti-infective with inactive (control) CVCs.
  
  
  METHODS
  Average insertion times were taken as a measurement of the length of insertion. Dichotomous data were combined using a fixed effect model and expressed as odds ratio (OR) with 95% confidence interval (CI95).
  
  
  RESULTS
  Two trials on antibiotic coating (343 CVCs) had an average insertion time of 6 days; the risk of BSI decreased from 5.1% with control to 0% with anti-infective catheters. There were no trials with longer average insertion times. In three trials on silver collagen cuffs (422 CVCs), the average insertion time ranged from 5 to 8.2 days (median, 7 days); the risk of BSI was 5.6% with control and 3.2% with anti-infective catheters. In another trial on silver collagen cuffs (101 CVCs), the average insertion time was 38 days; the risk of BSI was 3.7% with control and 4.3% with anti-infective catheters. In five trials on chlorhexidine-silver sulfadiazine coating (1,269 CVCs), the average insertion time ranged from 5.2 to 7.5 days (median, 6 days); the risk of BSI decreased from 4.1% with control to 1.9% with anti-infective catheters. In five additional trials on chlorhexidine-silver sulfadiazine coating (1,544 CVCs), the average insertion time ranged from 7.8 to 20 days (median, 12 days); the risk of BSI was 4.5% with control and 4.2% with anti-infective catheters.
  
  
  CONCLUSIONS
  Antibiotic and chlorhexidine-silver sulfadiazine coatings are anti-infective for short (approximately 1 week) insertion times. For longer insertion times, there are no data on antibiotic coating, and there is evidence of lack of effect for chlorhexidine-silver sulfadiazine coating. For silver-impregnated collagen cuffs, there is evidence of lack of effect for both short- and long-term insertion.
authors.affiliation: Division of Surgical Intensive Care, University of Geneva Hospitals, Geneva, Switzerland.
authors.forename: Bernhard
authors.initials: B
authors.lastname: Walder
authors.forename: Didier
authors.initials: D
authors.lastname: Pittet
authors.forename: Martin R
authors.initials: MR
authors.lastname: Tramèr
mesh_terms: D000287:Administration, Topical; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000517:prevention & control*; D001422:Bacterial Adhesion / Q000187:drug effects; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000382:microbiology*; D020099:Coated Materials, Biocompatible; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible