Effectiveness of impregnated central venous catheters for catheter related blood stream infection: a systematic review.
OBJECTIVE
Clinicians need information on the relative effectiveness of different types of impregnated central venous catheter for serious infection and their relative costs and adverse effects in order to decide which type, if any, to use.


RESULTS
We systematically reviewed 37 randomized controlled trials involving 11 586 patients. Only seven studies were classified as good on all measures of study quality. Compared with standard catheters, significant and substantial reductions in catheter-related blood stream infection were found for heparin-coated and antibiotic-impregnated central venous catheters. We found no statistically significant benefits of antiseptic central venous catheters, coated with chlorhexidine and silver sulphadiazine, or sliver-impregnated central venous catheters, compared with standard catheters. The few 'head-to-head' comparisons confirmed the benefits of antibiotic impregnation compared with chlorhexidine and silver sulphadiazine or silver impregnation, but no significant difference was found for heparin-coated compared with silver-impregnated central venous catheters. No studies reported serious adverse events, but there is some evidence of antibiotic resistance from in-vitro studies. No impregnated central venous catheter exists for neonates weighing less than 3 kg, and few studies have been undertaken in larger children.


CONCLUSIONS
The most promising options for reducing catheter-related blood stream infection are heparin-coated or antibiotic-impregnated central venous catheters. Large, high-quality randomized controlled trials are needed to evaluate which of these methods is most effective for reducing clinically important consequences of catheter-associated infection.
Gilbert
Ruth E
RE
Centre for Evidence-based Child Health, MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, UK. r.gilbert@ich.ucl.ac.uk
Harden
Melissa
M
D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D000925:Anticoagulants / Q000008:administration & dosage; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002710:Chlorhexidine / Q000008:administration & dosage; D003428:Cross Infection / Q000209:etiology / Q000517:prevention & control*; D004866:Equipment Contamination; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D018805:Sepsis / Q000209:etiology / Q000517:prevention & control*; D012837:Silver Sulfadiazine / Q000008:administration & dosage
D000891:Anti-Infective Agents, Local; D000925:Anticoagulants; D006493:Heparin; D002710:Chlorhexidine; D012837:Silver Sulfadiazine