Anti-infective-tfeated central venous catheters clinical effectiveness and safety

摘要

The risk of catheter-related bloodstream infections (CRBSIs) may therefore be reduced by using anti-infective-treated central venous catheters (CVC). The aim of this article is to assess the clinical effectiveness and safety of CVCs treated with anti-infective agents. A review of the literature was carried out to identify the various anti-infective agents used, and to monitor the primary endpoints (CVC lifetime, duration of hospitalization, emergence of resistance, tolerance) and secondary end points (colonization and bloodstream infection). This review was limited to randomized controlled trials (RCTs). Twenty describe CVC impregnated with a combination of chlorhexidine and silver sulfadiazine (C/SA), seven a combination of minocycline and rifampicin (M/R), 7 are silver coated CVC and 2 a combination of rifampicin and miconazol (R/Mi). Sixteen RCTs show a significant decrease in CVC bacterial colonization, but only 9 of them have shown a significant reduction in sepsis. No improvement of the main criteria has been proved. The risk of anaphylaxis associated with CVC impregnated C/SA has been described since 1998. There is no clinical data related to the tolerance with the other antimicrobials used. The risk of resistance emergence has been evaluated in vitro. These studies are methodologically criticisable. They do not allow to validate the interest of this kind of catheter, which routine use remains controversial.