Antimicrobial-impregnated central venous catheters to prevent bloodstream infection in newborn infants

Review question: In newborn infants requiring a central venous catheter (CVC), are antimicrobial-impregnated CVCs compared to standard CVCs effective in preventing acquired bloodstream infection?

Background: Infection in the bloodstream is a frequent and harmful complication for newborn infants who have a central venous catheter (a cannula that extends several centimetres into the infant's blood vessel). While the catheter may provide a secure route for delivering drugs and nutrition, it may also be a locus for infecting organisms to grow and cause long-term or more severe infection. One potential method of reducing this serious complication is to use central venous catheters that contain antiseptics or antibiotics to stop organisms from sticking to or growing on the catheter.

Study characteristics: We found only one small randomised controlled trial (with 98 very preterm infants participating) that addressed this question.

Key results: This trial showed that central venous catheters containing antiseptics or antibiotics to stop organisms from sticking to or growing on the catheter could reduce the chance of infants developing a bloodstream infection by about 90%. Becasue the trial was small, however, this finding is not certain.

Conclusions: The trial did provide some evidence that antimicrobial-impregnated central venous catheters can prevent bloodstream infection in newborn infants, but further, large trials are needed to resolve this question fully.

Authors' conclusions: 

Although the data from one small trial indicates that antimicrobial-impregnated central venous catheters might prevent catheter-related bloodstream infection in newborn infants, the available evidence is insufficient to guide clinical practice. A large, simple and pragmatic randomised controlled trial is needed to resolve on-going uncertainty.

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Background: 

Central venous catheter-related bloodstream infection is an important cause of mortality and morbidity in newborn infants cared for in neonatal units. Potential strategies to prevent these infections include the use of central venous catheters impregnated with antimicrobial agents.

Objectives: 

To determine the effect of antimicrobial-impregnated central venous catheters in preventing catheter-related bloodstream infection in newborn infants.

Search strategy: 

We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2015, Issue 8), MEDLINE (1966 to September 2015), EMBASE (1980 to September 2015), CINAHL (1982 to September 2015), conference proceedings and previous reviews.

Selection criteria: 

Randomised or quasi-randomised controlled trials comparing central venous catheters impregnated or coated with any antibiotic or antiseptic versus central venous catheters without antibiotic or antiseptic coating or impregnation in newborn infants.

Data collection and analysis: 

We extracted data using the standard methods of the Cochrane Neonatal Group, with independent evaluation of risk of bias and data extraction by two review authors.

Main results: 

We found only one small trial (N = 98). This trial found that silver zeolite-impregnated umbilical venous catheters reduced the incidence of bloodstream infection in very preterm infants (risk ratio 0.11, 95% confidence interval 0.01 to 0.87; risk difference -0.17, 95% CI -0.30 to -0.04; number needed to treat for benefit 6, 95% CI 3 to 25].

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