Author Affiliations: Departments of Pharmacy (Drs Veenstra and Sullivan), Medicine (Drs Saint and Saha), Biostatistics (Dr Lumley), and Health Services (Dr Sullivan), University of Washington, Seattle. Dr Saint is now with the University of Michigan Medical Center, Ann Arbor.
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
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
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;
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
Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD. Efficacy of Antiseptic-Impregnated Central Venous Catheters in Preventing Catheter-Related Bloodstream Infection: A Meta-analysis. JAMA. 1999;281(3):261–267. doi:10.1001/jama.281.3.261
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