Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection - A meta-analysis

Context Central venous catheters impregnated with chlorhexidine and silver sulfadiazine have recently been introduced for the prevention of catheter-r elated infections, However, there remains some uncertainty regarding the ef ficacy of these catheters because of conflicting reports in the literature. Objective To evaluate the efficacy of chlorhexidine-silver sulfadiazine-imp regnated central venous catheters in the prevention of catheter-related blo odstream infection. Data Sources Studies identified from a computerized search of the MEDLINE d atabase from January 1966 to January 1998, reference lists of identified ar ticles, and queries of principal investigators and the catheter manufacture r. Study Selection Randomized trials comparing chlorhexidine-silver sulfadiazi ne-impregnated central venous catheters with nonimpregnated catheters were included. The outcomes assessed were catheter colonization and catheter-rel ated bloodstream infection confirmed by catheter culture. Data Extraction Twelve studies met the inclusion criteria for catheter colo nization and included a total of 2611 catheters, Eleven studies with a tota l of 2603 catheters met the inclusion criteria for catheter-related bloodst ream 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 (9 5% confidence interval [CI], 0.36-0.54; P<.001), indicating a significant d ecrease in catheter colonization associated with impregnated catheters. The studies examining the outcome of primary interest, catheter-related bloods tream infection, had a summary odds ratio of 0.56 (95% CI, 0.37-0.84; P =.0 05). Conclusions Central venous catheters impregnated with a combination of chlo rhexidine and silver sulfadiazine appear to be effective in reducing the in cidence of both catheter colonization and catheter-related bloodstream infe ction in patients at high risk for catheter-related infections.