Rachel D Kramer1, Mary A M Rogers2, Marisa Conte3, Jason Mann4, Sanjay Saint2, Vineet Chopra2. 1. University of Michigan School of Medicine, Ann Arbor, MI. Electronic address: rdkramer@med.umich.edu. 2. The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI; Division of General Internal Medicine, Department of Medicine, University of Michigan School of Medicine, Ann Arbor, MI. 3. Taubman Health Science Library, University of Michigan School of Medicine, Ann Arbor, MI. 4. The Patient Safety Enhancement Program and Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
Abstract
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.
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.
Authors: Amanda J Ullman; Deanne August; Tricia Kleidon; Rachel Walker; Nicole M Marsh; Andrew Bulmer; Benjamin Pearch; Naomi Runnegar; Jessica A Schults; Joanne Leema; Paul Lee-Archer; Cathy Biles; Katrina Southam; Victoria Gibson; Joshua Byrnes; Robert S Ware; Vineet Chopra; Alan Coulthard; Peter Mollee; Claire M Rickard; Patrick N A Harris Journal: BMJ Open Date: 2021-04-14 Impact factor: 2.692
Authors: Valerie M Vaughn; Megan O'Malley; Scott A Flanders; Tejal N Gandhi; Lindsay A Petty; Anurag N Malani; Allison Weinmann; Jennifer K Horowitz; Vineet Chopra Journal: JAMA Netw Open Date: 2020-10-01