Systematic review of antimicrobials for the prevention of haemodialysis catheter-related infections
| Autor: | Anatole Besarab, Kannaiyan S Rabindranath, James Adams, Carol Moore, Tarun Bansal, Ruma Das, Alison M. MacLeod, Ranjit Shail |
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| Rok vydání: | 2009 |
| Předmět: |
Clinical Trials as Topic
Transplantation medicine.medical_specialty business.industry Rate ratio Antimicrobial medicine.disease Surgery law.invention Clinical trial Catheter Anti-Infective Agents Randomized controlled trial Renal Dialysis Nephrology law Catheter-Related Infections Internal medicine Relative risk Bacteremia Chemoprophylaxis medicine Humans business |
| Zdroj: | Nephrology Dialysis Transplantation. 24:3763-3774 |
| ISSN: | 1460-2385 0931-0509 |
| DOI: | 10.1093/ndt/gfp327 |
| Popis: | Background Almost 30% of chronic haemodialysis (HD) patients are dependent on central venous catheters (CVCs) for their vascular access, and catheter-related bacteraemia (CRB) is the major reason for catheter loss and has been associated with substantial morbidity, including meta-static infections. This systematic review evaluates the benefits and harms of antimicrobial interventions for the prevention of catheter-related infections (CRIs). Methods MEDLINE (1950-May 2009), EMBASE (1980-May 2009) CENTRAL (up to May 2009) and bibliographies of retrieved articles were searched for relevant RCTs. Analysis was by a random effects model and results expressed as rate ratio, relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI). Results A total of 29 trials with 2886 patients and 3005 catheters were included. Antimicrobial catheter locks (AMLs) significantly reduced the rates of CRBs (rate ratio, 0.33, 95% CI 0.24-0.45) and exit-site infections (ESIs) (rate ratio 0.67, 95% CI 0.47-0.96). Exit-site antimicrobial application also significantly reduced the rates of CRBs (rate ratio 0.21, 95% CI 0.12-0.36) and ESIs (rate ratio 0.22, 95% CI 0.10-0.47). Antimicrobial coating of HD catheters and the use of peri-operative antimicrobials did not result in significant reduction in rates of CRBs and ESIs. Conclusion The use of AMLs and exit-site antimicrobials are useful measures in the reduction of CRIs, whereas antimicrobial impregnated catheters and peri-operative systemic antimicrobial administration have not been found to be beneficial. Further head-to-head trials of various AMLs and exit-site antimicrobials are needed to know about their comparative clinical efficacy. |
| Databáze: | OpenAIRE |
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