Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters.

OBJECTIVES To examine the effectiveness of antimicrobial-impregnated and heparin-bonded catheters relative to standard central venous catheters in lessening catheter-related bloodstream infections. DATA SOURCES Articles were identified by computer-assisted searching. STUDY SELECTION Studies were eliminated from further consideration if they did not contain original data relevant to lessening catheter-related bloodstream infections, were nonrandomized or uncontrolled, described subjects <17 yrs of age, or used animal subjects. DATA ABSTRACTION From each eligible article, we abstracted the following: a) citation; b) type of control; c) study setting; d) type of experimental catheter; e) catheter-specific complications; f) total numbers of patients and catheters; g) number of experimental catheters used that resulted in a catheter-related bloodstream infection; h) number of control catheters used that resulted in a catheter-related bloodstream infection; i) number of experimental catheters used without catheter-related bloodstream infections; and j) number of control catheters used without infections. We also recorded the duration of catheter use and the types of microbes cultured in association with the catheters and with catheter-related bloodstream infections. DATA SYNTHESIS Eleven eligible studies were identified. Using meta-analysis, we showed that antimicrobial-impregnated and heparin-bonded central venous catheters significantly decreased catheter-related bloodstream infections by 2.32% (95% confidence interval, 1.04% to 3.61%). CONCLUSIONS The modest additional cost for the use of these catheters relative to the considerable cost of treating even a single bloodstream infection makes their use cost-effective.