283. Do Antimicrobial Peripherally Inserted Central Catheters Reduce the Risk of Central Line-Associated Bloodstream Infection? A Systematic Review and Meta-Analysis
Session: Poster Abstract Session: HAI: Device Associated Infections
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Antimicrobial_PICCs_and_CLABSI_Risk_Systematic_Review.pdf (297.1 kB)
  • Background:

    While peripherally inserted central catheters (PICCs) are important in caring for patients, they are associated with central line-associated bloodstream infection (CLABSI). Antimicrobial PICCs are novel devices that may reduce the risk of CLABSI, but data are conflicting.

     

    Methods:

    We performed a systematic review and meta-analysis to evaluate whether antimicrobial PICCs reduce the risk of CLABSI. Relevant studies were identified by searching four databases (MEDLINE via Ovid, EMBASE, CINHAL and Web of Science) from inception to March 2015. Additional studies and data were identified through hand searches of bibliographies and direct inquires to authors. Studies that reported CLABSI outcomes between antimicrobial PICCs vs. non-coated central venous catheters were included. Two reviewers independently assessed study eligibility and abstracted data; discrepancies were resolved via consensus. Summary odds ratios (ORs) were calculated using a random effects meta-analysis.

    Results:

    Of 503 citations identified, four studies (two retrospective; one quasi-experimental and one prospective cohort study) involving 925 patients met eligibility criteria. Studies included adult and pediatric patients from intensive care, long-term care and general ward settings. The overall prevalence of CLABSI was 5.9% (55/925) with an average catheter dwell time of 66 days. Two studies utilized minocycline-rifampin PICCs and two included chlorhexidine-coated PICCs. Pooled data revealed that antimicrobial PICCs were associated with a significant decrease in CLABSI compared to non-coated central venous catheters (OR 0.11, 95% confidence interval [CI] 0.040.31, P <0.001; I2=0%, P=0.44). Significant differences in CLABSI reduction between minocycline-rifampin and chlorhexidine-coated devices were not observed (OR=0.11 vs. OR=0.08, p=0.89 respectively).

    Conclusion:

    Available data suggests that antimicrobial PICCs are associated with a significant reduction in CLABSI. However, the observational nature of the data, comparison to non-PICC devices and additional costs of these devices limit generalizability. Randomized trials appear necessary before widespread use can be recommended.

    Figure 1: Systematic Review Flow Diagram

    Articles assessed for eligibility
(n = 503)
,Articles excluded
(n = 499)
121  Review, Editorial, or Case Report
14  In Vitro and Animal Studies
210  PICC devices not included
154  Antimicrobial-coated PICCs not included
,Studies included in quantitative synthesis
(n = 4)
,Records after duplicates removed
(n = 503)
,Records identified through database searching
(n = 611)

    Figure 2: Forrest Plot

     

    Rachel Kramer, BS1, Marisa Conte, MLIS2, Jason Mann, MSA2, Sanjay Saint, MD, MPH, FSHEA3 and Vineet Chopra, MD, MSc2,4, (1)University of Michigan Medical School, Ann Arbor, MI, (2)Patient Safety Enhancement Program of the Ann Arbor VA Medical Center, Ann Arbor, MI, (3)Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, (4)Internal Medicine, University of Michigan Department of Internal Medicine, Ann Arbor, MI

    Disclosures:

    R. Kramer, None

    M. Conte, None

    J. Mann, None

    S. Saint, None

    V. Chopra, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.