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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
Authors
Walder, Bernhard
Pittet, Didier
Tramer, Martin
Published in Infection control and hospital epidemiology. 2002, vol. 23, no. 12, p. 748-756
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. DESIGN: Systematic review of randomized, controlled trials comparing anti-infective with inactive (control) CVCs. INTERVENTIONS: 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.
Keywords Administration, Topical — Anti-Infective Agents/ administration & dosage — Bacteremia/ prevention & control — Bacterial Adhesion/drug effects — Catheterization, Central Venous/ instrumentation — Catheters, Indwelling/ microbiology — Coated Materials, Biocompatible — Cross Infection/ prevention & control — Humans — Randomized Controlled Trials as Topic — Time Factors — Treatment Outcome
Identifiers
PMID: 12517018
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Article - document accessible for UNIGE members only Limited access to UNIGE
Structures
Faculté de médecine / Section de médecine clinique / Département de médecine
Research group Staphylocoques dorés résistants à la méthicilline et hygiène hospitalière (330)
Citation
(ISO format) 		WALDER, Bernhard, PITTET, Didier, TRAMER, Martin. 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. In: Infection control and hospital epidemiology, 2002, vol. 23, n° 12, p. 748-756. doi: 10.1086/502005 https://archive-ouverte.unige.ch/unige:7680

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Deposited on : 2010-06-21

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