Antimicrobial central venous catheters in adults: a systematic review and meta-analysis

Several antimicrobial central venous catheters (CVCs) are available. We did a meta-analysis to assess their efficacy in reducing microbial colonisation and preventing catheter-related bloodstream infection (CRBSI). An extensive literature search of articles in any language was undertaken. We assessed randomised clinical trials in which available antimicrobial CVCs were compared with either a standard CVC or another antimicrobial CVC. Outcomes assessed were microbial colonisation of CVCs and CRBSI. The first-generation chlorhexidine-silver sulfadiazine (CSS) CVCs reduce colonisation (odds ratio [OR] 0.51 [95% CI 0.42-0.61]) and CRBSI (OR 0.68 [0.47-0.98]), as do the minocycline-rifampicin CVCs (OR 0.39 [0.27-0.55] and OR 0.29 [0.16-0.52], respectively). The minocycline-rifampicin CVCs outperformed the first-generation CSS CVCs in reducing colonisation (OR 0.34 [0.23-0.49]) and CRBSI (OR 0.18 [0.07-0.51]). Many shortcomings in methodological quality limit our interpretation of the study results. However, the available evidence suggests that use of CSS and minocycline-rifampicin CVCs are useful if the incidence of CRBSI is above institutional goals despite full implementation of infection prevention interventions.