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Are antimicrobial peripherally inserted central catheters associated with reduction in central line-associated
Rachel D Kramer1, Mary A M Rogers2, Marisa Conte3
1University of Michigan School of Medicine, Ann Arbor, MI.
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.
Insights
Antimicrobial peripherally inserted central catheters (PICCs) significantly reduce central line-associated bloodstream infections (CLABSI). These antimicrobial PICCs are especially effective in high-risk patient groups, preventing one CLABSI for every 26 patients treated.
Area of Science:
- Infectious Diseases
- Medical Devices
- Public Health
Background:
- Central line-associated bloodstream infections (CLABSI) pose a significant risk.
- Antimicrobial peripherally inserted central catheters (PICCs) are a potential preventative measure.
- Limited data exist on the efficacy of antimicrobial PICCs in reducing CLABSI.
Purpose of the Study:
- To evaluate the association between antimicrobial PICCs and CLABSI reduction.
- To synthesize existing evidence on the effectiveness of antimicrobial PICCs.
Main Methods:
- Comprehensive literature search of MEDLINE, EMBASE, CINHAL, and Web of Science.
- Inclusion of 8 studies with 12,879 patients.
- Independent data extraction and study selection by two authors.
Main Results:
- Antimicrobial PICCs were associated with a significant reduction in CLABSI (RR, 0.29).
- The incidence of CLABSI was 0.2% with antimicrobial PICCs versus 5.3% without.
- Treatment of 26 patients with antimicrobial PICCs prevented one CLABSI; greater reduction seen in high-risk adults.
Conclusions:
- Antimicrobial PICCs demonstrate potential in reducing CLABSI, particularly in high-risk populations.
- Further randomized trials are recommended to confirm efficacy across diverse patient groups.
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