抗感染型中心静脉导管在完全胃肠外营养或治疗中的作用----系统性文献综述

David

Journal of Hospital Infection online 25 April 2008
Article in Press, Corrected Proof  
Review
Anti-infective-treated central venous catheters for total parenteral nutrition or chemotherapy: a systematic review
抗感染型中心静脉导管在完全胃肠外营养或治疗中的作用----系统性文献综述
B.S. Niel-Weisea, , , T. Stijnenb and P.J. van den Broekc

aDutch Working Party on Infection Prevention, Leiden, The Netherlands

bDepartment of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands

cDepartment of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands


Available online 25 April 2008.

Summary
This systematic review assesses the effect of anti-infective-treated central venous catheters (CVCs) on catheter-related bloodstream infection (CRBSI) in patients who received a CVC for total parenteral nutrition (TPN) or chemotherapy. Randomised controlled trials were retrieved from Medline and the Cochrane Library up to 14 October 2007. Two reviewers independently assessed trial quality and extracted data. Data for CRBSI were combined where appropriate, using a random effects model, and subgroup meta-analysis was carried out where applicable. The impact of the risk for CRBSI in the control group on the effect of anti-infective CVCs was studied by using meta-regression based on the bivariate meta-analysis model. Nine trials were included in the review. One trial showed that antibiotic-treated CVCs reduced the risk for CRBSI in outpatients with chemotherapy and a CVC in-situ during a period of about nine weeks. Eight trials did not find an overall significant benefit in favour of antiseptic-treated CVCs in patients who had a CVC during a mean of about two weeks. No relationship could be established between the effect of anti-infective-treated CVCs and the underlying risk for CRBSI, although nearly all trials had serious methodological shortcomings. Thus, available scientific evidence to prevent CRBSI by the use of anti-infective-treated CVCs in patients receiving chemotherapy or TPN is not sufficient as a basis to recommend their use. The recommendation of the Centers for Disease Control and Prevention to use antibiotic- or antiseptic-impregnated CVCs, when the risk for CRBSI remains high despite good hygienic practice, should therefore be limited to patients in the intensive care/perioperative setting.

Keywords: Catheter-related bloodstream infection; Central venous catheter; Antibiotics; Antiseptics; Systematic review