A systematic review comparing the relative effectiveness of antimicrobial-coated catheters in intensive care units.
BACKGROUND
Bloodstream infection related to a central venous catheter is a substantial clinical and economic problem. To develop policy for managing the risks of these infections, all available evidence for prevention strategies should be synthesized and understood.


METHODS
We evaluate evidence (1985-2006) for short-term antimicrobial-coated central venous catheters in lowering rates of catheter-related bloodstream infection (CRBSI) in the adult intensive care unit. Evidence was appraised for inclusion against predefined criteria. Data extraction was by 2 independent reviewers. Thirty-four studies were included in the review. Antiseptic, antibiotic, and heparin-coated catheters were compared with uncoated catheters and one another. Metaanalysis was used to generate summary relative risks for CRBSI and catheter colonization by antimicrobial coating.


RESULTS
Externally impregnated chlorhexidine/silver sulfadiazine catheters reduce risk of CRBSI relative to uncoated catheters (RR, 0.66; 95% CI: 0.47-0.93). Minocycline and rifampicin-coated catheters are significantly more effective relative to CHG/SSD catheters (RR, 0.12; 95% CI: 0.02-0.67). The new generation chlorhexidine/silver sulfadiazine catheters and silver, platinum, and carbon-coated catheters showed nonsignificant reductions in risk of CRBSI compared with uncoated catheters.


CONCLUSIONS
Two decades of evidence describe the effectiveness of antimicrobial catheters in preventing CRBSI and provide useful information about which catheters are most effective. Questions surrounding their routine use will require supplementation of this trial evidence with information from more diverse sources.
Ramritu
Prabha
P
The Centre for Healthcare Related Infection Surveillance & Prevention, Brisbane, QLD, Australia.
Halton
Kate
K
Collignon
Peter
P
Cook
David
D
Fraenkel
David
D
Battistutta
Diana
D
Whitby
Michael
M
Graves
Nicholas
N
D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002244:Carbon / Q000494:pharmacology; D002404:Catheterization / Q000009:adverse effects*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000494:pharmacology; D003428:Cross Infection / Q000517:prevention & control*; D006801:Humans; D007362:Intensive Care Units; D008911:Minocycline / Q000494:pharmacology; D010984:Platinum / Q000494:pharmacology; D012293:Rifampin / Q000494:pharmacology; D018805:Sepsis / Q000517:prevention & control*; D012834:Silver / Q000494:pharmacology
D000900:Anti-Bacterial Agents; D012834:Silver; D010984:Platinum; D002244:Carbon; D008911:Minocycline; D002710:Chlorhexidine; D012293:Rifampin