Anti-infective-treated central venous catheters: a systematic review of randomized controlled trials.
OBJECTIVE
This systematic review assesses the effect of anti-infective-treated central venous catheters (CVCs) on catheter-related bloodstream infection (CRBSI) in the acute care setting.


METHODS
Randomized controlled trials were retrieved from Medline and the Cochrane Library up to 15 January 2007. Two reviewers independently assessed trial quality and extracted data. Data for CRBSI were combined where appropriate, using a random effects model. The impact of the risk for CRBSI in the control group (baseline risk) on the benefit of anti-infective CVCs was studied by using meta-regression based on the binomial normal bivariate meta-analysis model.


RESULTS
Twenty-one trials were included in the review. Mainly intensive care (IC) patients were studied. Eighteen trials showed that anti-infective CVCs reduced the risk of CRBSI. The number needed to treat (NNT) varied from 182 to 12, with baseline risks ranging from 1% to 10%. Nearly all trials had serious methodological shortcomings. Three trials comparing minocycline-rifampicin-treated catheters with antiseptic-treated catheters showed inconsistent results. One trial suggested that there is not any difference in CRBSI between heparin- and antiseptic-treated CVCs.


CONCLUSIONS
Because the NNT is large when the baseline risk is low, the use of anti-infective-treated CVCs in the acute care setting should only be considered in situations in which background rates of CRBSI are high. The magnitude of benefit as calculated in this review should be interpreted with caution because of strong arguments in favor of a systematic overestimation of the effect. Which type of anti-infective catheter is most effective could not be established from the available data.
Niël-Weise
B S
BS
Dutch Working Party on Infection Prevention, PO Box 9600, 2300 RC Leiden, The Netherlands. b.s.niel-weise@lumc.nl
Stijnen
T
T
van den Broek
P J
PJ
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D003428:Cross Infection / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D016032:Randomized Controlled Trials as Topic
D000890:Anti-Infective Agents