Rifampin and minocycline impregnated central venous catheters: a meta-analysis of randomised controlled trials assessing catheter colonisation and catheter-related bloodstream infection
Abstract number: p1006
Falagas M., Fragoulis K., Bliziotis I., Chatzinikolaou I.
The use of antimicrobial-impregnated central venous catheters (CVC) for the prevention of CVC microbial colonization and of catheter-related bloodstream infection (CRBSI) is a controversial subject. We performed a meta-analysis of randomised controlled trials (RCT) of CVCs coated with rifampin-based antimicrobial combinations in order to further evaluate this subject.
The assessed primary outcomes were microbial colonization of the CVC and CRBSI. The analysed secondary outcomes were the occurrence of adverse events, emergence of resistant organisms and all cause mortality. Our main analysis included RCTs that compared the efficacy of CVCs impregnated with rifampin and minocycline to that of non-impregnated with antibiotics CVCs.
8 RCTs fulfilled our inclusion criteria, comparing 1262 CVCs impregnated with rifampin-based antimicrobial combinations to 1236 non-impregnated with antibiotics CVCs. Our primary analysis showed that rifampin-minocycline impregnated CVCs were associated with lesser rates of colonization (OR 0.41, 95% CI 0.250.68) and CRBSI (OR 0.21, 95% CI 0.100.43). Sub analyses of studies comparing rifampin-minocycline impregnated CVCs to non-tunnelled, non-antimicrobial-impregnated CVCs (5 studies) demonstrated superiority of the impregnated catheters in preventing colonization (OR 0.35, 95% CI 0.240.52) and CRBSI (OR 0.21, 95% CI 0.100.43). Further analysis, of RCTs comparing CVCs impregnated with any rifampin-based combination of antimicrobials to non-impregnated with antibiotics CVCs (all 8 RCTs), demonstrated superiority of the rifampin-based combinations in reducing colonization (OR 0.33, 95% CI 0.190.58), and CRBSI (OR 0.17, 95% CI 0.090.32). None of the RCTs reported significant increase in mortality, toxicity, or emergence of resistance in any of the studied groups.
Rifampin-minocycline impregnated CVC are safe and effective in reducing the rate of CVC colonization and CRBSI. Additional RCTs are needed to provide more information on cost analysis, on the possibility of emergence of microbial resistance, to evaluate more their benefit in long-term catheterisation and to compare them versus the new generation of CHSS coated CVC.
|Session name:||XXIst ISTH Congress|
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