Van de Wetering, M.D., Van Woensel, J., & Lawrie, T.A. (2013). Prophylactic antibiotics for preventing gram positive infections associated with long-term central venous catheters in oncology patients. Cochrane Database of Systematic Reviews, 11, CD003295. 

DOI Link

Purpose

STUDY PURPOSE: To determine the effectiveness of administering antibiotics prior to long-term central venous catheter (CVC) insertion, or flushing to prevent catheter-related infections

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, EMBASE, Cochrane Collaboration (1966–2013), hand search of conference proceedings
 
INCLUSION CRITERIA: Randomized, controlled trials (RCTs) comparing prophylactic antibiotics to no antibiotics prior to CVC insertion, RCTs comparing a combined antibiotic and heparin solution to heparin only to flush or lock newly inserted catheters, and RCTs comparing a combination of these; studies of adults or children
 
EXCLUSION CRITERIA: Nontunneled CVCs, noncancer samples, designs other than RCTs

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 558
 
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane handbook for systematic reviews and additional assessment for quality of randomization, blinding, and analysis. Evidence was deemed to be of moderate quality.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 11
  • TOTAL PATIENTS INCLUDED IN REVIEW = 828
  • SAMPLE RANGE ACROSS STUDIES: 27–108 patients
  • KEY SAMPLE CHARACTERISTICS: Patients with varied tumor types

Phase of Care and Clinical Applications

PHASE OF CARE: Not specified or not applicable
 
APPLICATIONS: Pediatrics

Results

Five studies evaluated prophylactic antibiotic administration prior to CVC insertion, and six studies evaluated flush or catheter lock solutions. Pooled analysis of evidence comparing antibiotic and heparin solution to heparin only solution showed that the combination of antibiotic was associated with less catheter-related sepsis than the heparin only solution (468 participants, relative risk [RR] = 0.47, 95% confidence interval [CI] [0.28, 0.8], p = 0.0051). The majority of these instances were in children, and low heterogeneity existed among these studies. Five of the six studies used vancomycin in the flush mixture. No difference existed in the risk of catheter-related infections between those who did and did not receive prophylactic antibiotics prior to CVC insertion.

Conclusions

This review did not demonstrate a beneficial effect of prophylactic antibiotics prior to long-term CVCD insertion. The findings suggest that the use of antimicrobial catheter flush or lock solutions may be helpful for infection reduction from gram-positive organisms; however, the majority of studies used vancomycin, which has been not recommended for standard use.

Limitations

  • Low sample sizes
  • Lack of specificity and consistency in outcomes

Nursing Implications

The use of catheter flush and lock solutions that contain a combination of antibiotics and heparin may help prevent or reduce catheter-related infection in patients with long-term tunneled central venous catheters.

Legacy ID

6055