Efficacy of Antiseptic-Impregnated Central Venous Catheters in Preventing Catheter-Related Bloodstream Infection: A Meta-Analysis

JAMA. 1999 Jan 20;281(3):261-7. doi: 10.1001/jama.281.3.261.

Abstract

Context: Central venous catheters impregnated with chlorhexidine and silver sulfadiazine have recently been introduced for the prevention of catheter-related infections. However, there remains some uncertainty regarding the efficacy of these catheters because of conflicting reports in the literature.

Objective: To evaluate the efficacy of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in the prevention of catheter-related bloodstream infection.

Data sources: Studies identified from a computerized search of the MEDLINE database from January 1966 to January 1998, reference lists of identified articles, and queries of principal investigators and the catheter manufacturer.

Study selection: Randomized trials comparing chlorhexidine-silver sulfadiazine-impregnated central venous catheters with nonimpregnated catheters were included. The outcomes assessed were catheter colonization and catheter-related bloodstream infection confirmed by catheter culture.

Data extraction: Twelve studies met the inclusion criteria for catheter colonization and included a total of 2611 catheters. Eleven studies with a total of 2603 catheters met the inclusion criteria for catheter-related bloodstream infection. Most patients in these studies were from groups considered to be at high risk for catheter-related infections. Summary statistics were calculated using Mantel-Haenszel methods under a fixed-effects model.

Data synthesis: The summary odds ratio for catheter colonization was 0.44 (95% confidence interval [CI], 0.36-0.54; P<.001), indicating a significant decrease in catheter colonization associated with impregnated catheters. The studies examining the outcome of primary interest, catheter-related bloodstream infection, had a summary odds ratio of 0.56 (95% CI, 0.37-0.84; P = .005).

Conclusions: Central venous catheters impregnated with a combination of chlorhexidine and silver sulfadiazine appear to be effective in reducing the incidence of both catheter colonization and catheter-related bloodstream infection in patients at high risk for catheter-related infections.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Anti-Infective Agents, Local* / administration & dosage
  • Antisepsis
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / instrumentation*
  • Chlorhexidine* / administration & dosage
  • Cross Infection / etiology
  • Cross Infection / prevention & control*
  • Equipment Contamination / prevention & control
  • Humans
  • Randomized Controlled Trials as Topic
  • Sensitivity and Specificity
  • Sepsis / etiology
  • Sepsis / prevention & control*
  • Silver Sulfadiazine* / administration & dosage

Substances

  • Anti-Infective Agents, Local
  • Chlorhexidine
  • Silver Sulfadiazine