Central venous catheter-related infections: a systematic review, meta-analysis, trial sequential analysis and meta-regression comparing ultrasound guidance and landmark technique for insertion.

Autor: Boulet N; UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France. nicolas.boulet@chu-nimes.fr., Pensier J; Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, Montpellier, France., Occean BV; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France., Peray PF; Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, CHU Nimes, Univ Montpellier, Nimes, France., Mimoz O; INSERM U1070, Université de Poitiers, and Service des Urgences Adultes & SAMU 86, CHU de Poitiers, Poitiers, France., Rickard CM; Metro North Health and The University of Queensland, Brisbane, Australia., Buetti N; Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals, Geneva, Switzerland.; Infection Antimicrobials Modeling Evolution (IAME) U 1137, INSERM, Université Paris-Cité, Paris, France., Lefrant JY; UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France., Muller L; UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France., Roger C; UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
Jazyk: angličtina
Zdroj: Critical care (London, England) [Crit Care] 2024 Nov 19; Vol. 28 (1), pp. 378. Date of Electronic Publication: 2024 Nov 19.
DOI: 10.1186/s13054-024-05162-0
Abstrakt: Background: During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique.
Methods: A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed.
Results: Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53-0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49-0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41-0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48-0.87).
Conclusion: US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.
Competing Interests: Declarations Ethics approval and consent to participate Not relevant. Consent for publication Not relevant. Competing interests The authors declare no competing interests.
(© 2024. The Author(s).)
Databáze: MEDLINE
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