Are antimicrobial peripherally inserted central catheters associated with reduction in central line-associated bloodstream infection? A systematic review and meta-analysis.
BACKGROUND
Antimicrobial peripherally inserted central catheters (PICCs) may reduce the risk of central line-associated bloodstream infection (CLABSI). However, data regarding efficacy are limited. We aimed to evaluate whether antimicrobial PICCs are associated with CLABSI reduction.


METHODS
MEDLINE, EMBASE, CINHAL, and Web of Science were searched from inception to July 2016; conference proceedings were searched to identify additional studies. Study selection and data extraction were performed independently by 2 authors.


RESULTS
Of 597 citations identified, 8 studies involving 12,879 patients met eligibility criteria. Studies included adult and pediatric patients from intensive care, long-term care, and general ward settings. The incidence of CLABSI in patients with antimicrobial PICCs was 0.2% (95% confidence interval [CI], 0.0%-0.5%), and the incidence among nonantimicrobial catheters was 5.3% (95% CI, 2.6%-8.8%). Compared with noncoated PICCs, antimicrobial PICCs were associated with a significant reduction in CLABSI (relative risk [RR], 0.29; 95% CI, 0.10-0.78). Statistical heterogeneity (I2, 71.6%; T2 = 1.07) was resolved by publication type, with peer-reviewed articles showing greater reduction in CLABSI (RR, 0.21; 95% CI, 0.06-0.74). Twenty-six patients (95% CI, 21-75) need to be treated with antimicrobial PICCs to prevent 1 CLABSI. Studies of adults at greater baseline risk of CLABSI experienced greater reduction in CLABSI (RR, 0.20; P = .003).


CONCLUSIONS
Available evidence suggests that antimicrobial PICCs may reduce CLABSI, especially in high-risk subgroups. Randomized trials are needed to assess efficacy across patient populations.
University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: rdkramer@med.umich.edu.
Rachel D
RD
Kramer
The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Internal Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
Mary A M
MA
Rogers
Taubman Health Science Library, University of Michigan School of Medicine, Ann Arbor, MI.
Marisa
M
Conte
The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Jason
J
Mann
The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Internal Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
Sanjay
S
Saint
The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Internal Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
Vineet
V
Chopra
D000890:Anti-Infective Agents / Q000008:administration & dosage*; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods*; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D018805:Sepsis / Q000453:epidemiology*
D000890:Anti-Infective Agents
Antimicrobial-coated; Central venous access; Infection prevention