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Am J Infect Control. 2017 Feb 1;45(2):108-114. doi: 10.1016/j.ajic.2016.07.021. Epub 2016 Oct 27.

Are antimicrobial peripherally inserted central catheters associated with reduction in central line-associated bloodstream infection? A systematic review and meta-analysis.

Author information

1
University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: rdkramer@med.umich.edu.
2
The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Internal Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI.
3
Taubman Health Science Library, University of Michigan School of Medicine, Ann Arbor, MI.
4
The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.

Abstract

BACKGROUND:

Antimicrobial peripherally inserted central catheters (PICCs) may reduce the risk of central line-associated bloodstream infection (CLABSI). However, data regarding efficacy are limited. We aimed to evaluate whether antimicrobial PICCs are associated with CLABSI reduction.

METHODS:

MEDLINE, EMBASE, CINHAL, and Web of Science were searched from inception to July 2016; conference proceedings were searched to identify additional studies. Study selection and data extraction were performed independently by 2 authors.

RESULTS:

Of 597 citations identified, 8 studies involving 12,879 patients met eligibility criteria. Studies included adult and pediatric patients from intensive care, long-term care, and general ward settings. The incidence of CLABSI in patients with antimicrobial PICCs was 0.2% (95% confidence interval [CI], 0.0%-0.5%), and the incidence among nonantimicrobial catheters was 5.3% (95% CI, 2.6%-8.8%). Compared with noncoated PICCs, antimicrobial PICCs were associated with a significant reduction in CLABSI (relative risk [RR], 0.29; 95% CI, 0.10-0.78). Statistical heterogeneity (I2, 71.6%; T2 = 1.07) was resolved by publication type, with peer-reviewed articles showing greater reduction in CLABSI (RR, 0.21; 95% CI, 0.06-0.74). Twenty-six patients (95% CI, 21-75) need to be treated with antimicrobial PICCs to prevent 1 CLABSI. Studies of adults at greater baseline risk of CLABSI experienced greater reduction in CLABSI (RR, 0.20; P = .003).

CONCLUSIONS:

Available evidence suggests that antimicrobial PICCs may reduce CLABSI, especially in high-risk subgroups. Randomized trials are needed to assess efficacy across patient populations.

KEYWORDS:

Antimicrobial-coated; Central venous access; Infection prevention

PMID:
28341283
DOI:
10.1016/j.ajic.2016.07.021
[Indexed for MEDLINE]

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