M D van de Wetering1, J B M van Woensel, L C M Kremer, H N Caron. 1. Paediatric Oncology Department, Emma Children's Hospital/Academic Medical Centre, F8-245, Meibergdreef 9, 1105 AD Amsterdam, The Netherlands. m.d.vandewetering@amc.uva.nl
Abstract
OBJECTIVE: Long-term tunnelled central venous catheters (TCVC) are increasingly used in oncology patients. Infections are a frequent complication of TCVC, mostly caused by Gram-positive bacteria. The objective of this review is to evaluate the efficacy of antibiotics in the prevention of early Gram-positive TCVC infections, in oncology patients. DATA SOURCES: We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register up to July 2003. REVIEW METHODS: We selected randomised controlled trials (RCT) evaluating prophylactic antibiotics prior to insertion of the TCVC, and the combination of an antibiotic and heparin to flush the TCVC, in paediatric and adult oncology patients. The primary outcome was documented Gram-positive bacteraemia in patients with a TCVC. All trials identified were assessed and the data extracted independently by two reviewers. RESULTS: There were nine trials included. Four trials reported on vancomycin/teicoplanin prior to insertion of the TCVC compared to no antibiotics. There was no reduction in the number of Gram-positive TCVC infections with an Odds ratio of 0.42 (95% confidence interval 0.13-1.31). Five trials studied flushing of the TCVC with a vancomycin/heparin solution compared to heparin flushing only. This method decreased the number of TCVC infections significantly with an Odds ratio of 0.43 (95% CI 0.21-0.87). CONCLUSION: Flushing the TCVC with a vancomycin/heparin solution reduced the incidence of Gram-positive infections.
OBJECTIVE: Long-term tunnelled central venous catheters (TCVC) are increasingly used in oncology patients. Infections are a frequent complication of TCVC, mostly caused by Gram-positive bacteria. The objective of this review is to evaluate the efficacy of antibiotics in the prevention of early Gram-positive TCVC infections, in oncology patients. DATA SOURCES: We searched MEDLINE, EMBASE, and the Cochrane Controlled Trials Register up to July 2003. REVIEW METHODS: We selected randomised controlled trials (RCT) evaluating prophylactic antibiotics prior to insertion of the TCVC, and the combination of an antibiotic and heparin to flush the TCVC, in paediatric and adult oncology patients. The primary outcome was documented Gram-positive bacteraemia in patients with a TCVC. All trials identified were assessed and the data extracted independently by two reviewers. RESULTS: There were nine trials included. Four trials reported on vancomycin/teicoplanin prior to insertion of the TCVC compared to no antibiotics. There was no reduction in the number of Gram-positive TCVC infections with an Odds ratio of 0.42 (95% confidence interval 0.13-1.31). Five trials studied flushing of the TCVC with a vancomycin/heparin solution compared to heparinflushing only. This method decreased the number of TCVC infections significantly with an Odds ratio of 0.43 (95% CI 0.21-0.87). CONCLUSION:Flushing the TCVC with a vancomycin/heparin solution reduced the incidence of Gram-positive infections.
Authors: Jose Garnacho-Montero; Teresa Aldabó-Pallás; Mercedes Palomar-Martínez; Jordi Vallés; Benito Almirante; Rafael Garcés; Fabrio Grill; Miquel Pujol; Cristina Arenas-Giménez; Eduard Mesalles; Ana Escoresca-Ortega; Marina de Cueto; Carlos Ortiz-Leyba Journal: Intensive Care Med Date: 2008-07-12 Impact factor: 17.440