背景:使用中心静脉导管(CVC)时,导管相关性血流感染(CRBSI)是最常见的并发症。束下涂覆CVC是否可以进一步降低CRBSI的发生率尚不清楚。我们旨在评估使用抗菌涂层的CVC束预防导管相关血流感染的有效性。
方法:在本系统综述和网络荟萃分析中,除EMBASE外,我们还在Cochrane图书馆中搜索了Cochrane中央对照试验登记册(CENTRAL),MEDLINE,CINAHL,和WebofScience数据库,用于2017年7月之前发表的研究。主要结果是每1000导管天的CRBSI率,次要结局是导管定植的发生率。
结果:23项研究显示,抗菌药物浸渍和标准CVC每1000个导管天的CRBSI比率存在显著差异(RR0.70,95%CI0.53-0.91,p=0.008)。包括33项试验,包括10,464名接受四种类型CVC之一的患者。与标准导管相比,氯己定/磺胺嘧啶银和抗生素涂层导管每1000个导管天的CRBSI数量较低(ORs和95%CrIs:0.64(0.40-0.955)和0.53(0.25-0.95),分别)和较低的导管定植发生率(OR和95%CrIs:0.44(0.34-0.56)和0.30(0.20-0.46),分别)。
结论:用氯己定/磺胺嘧啶银或其他抗生素浸渍的导管在预防CRBSI和束下导管定植方面优于标准导管。与银离子浸渍的CVC相比,氯己定/磺胺嘧啶银抗菌导管减少了导管微生物定植的病例,但并未减少CRBSI。
BACKGROUND: Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under
bundles could further reduce the incidence of CRBSIs is unclear. We aimed to assess the effectiveness of implementing the use of
bundles with antimicrobial-coated CVCs for preventing catheter-related blood-stream infections.
METHODS: In this systematic review and network meta-analyses, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library in addition to the EMBASE, MEDLINE, CINAHL, and Web of Science databases for studies published before July 2017. The primary outcome was the rate of CRBSIs per 1000 catheter-days, and the secondary outcome was the incidence of catheter colonization.
RESULTS: Twenty-three studies revealed significant differences in the rate of CRBSIs per 1000 catheter-days between antimicrobial-impregnated and standard CVCs (RR 0.70, 95% CI 0.53-0.91, p = 0.008). Thirty-three trials were included containing 10,464 patients who received one of four types of CVCs. Compared with a standard catheter, chlorhexidine/silver sulfadiazine- and antibiotic-coated catheters were associated with lower numbers of CRBSIs per 1000 catheter-days (ORs and 95% CrIs: 0.64 (0.40-0.955) and 0.53 (0.25-0.95), respectively) and a lower incidence of catheter colonization (ORs and 95% CrIs: 0.44 (0.34-0.56) and 0.30 (0.20-0.46), respectively).
CONCLUSIONS: Outcomes are superior for catheters impregnated with chlorhexidine/silver sulfadiazine or other antibiotics than for standard catheters in preventing CRBSIs and catheter colonization under
bundles. Compared with silver ion-impregnated CVCs, chlorhexidine/silver sulfadiazine antiseptic catheters resulted in fewer cases of microbial colonization of the catheter but did not reduce CRBSIs.