Systematic Review Effect of skin antiseptic solutions on the incidence of catheter-related bloodstream infection: a systematic review and network meta-analysis

被引:17
作者
Masuyama, T. [1 ]
Yasuda, H. [2 ,3 ]
Sanui, M. [1 ]
Lefor, A. K. [4 ]
机构
[1] Jichi Med Univ, Saitama Med Ctr, Dept Anaesthesiol & Crit Care Med, Saitama, Japan
[2] Jichi Med Univ, Saitama Med Ctr, Dept Emergency & Crit Care Med, Saitama, Japan
[3] Keio Univ Hosp, Clin & Translat Res Ctr, Dept Clin Res Educ & Training Unit, Tokyo, Japan
[4] Jichi Med Univ, Dept Surg, Shimotsuke, Tochigi, Japan
关键词
Chlorhexidine; Povidone-iodine; Skin antiseptic solution; Catheter-related bloodstream; infection; Systematic review; Network meta-analysis; PROSPECTIVE RANDOMIZED-TRIAL; 10-PERCENT POVIDONE-IODINE; CRITICALLY-ILL PATIENTS; CHLORHEXIDINE; PREVENTION; CARE; COLONIZATION; ALCOHOL; MULTICENTER; EFFICACY;
D O I
10.1016/j.jhin.2021.01.017
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: The most effective skin antiseptic solution to reduce the incidence of catheterrelated bloodstream infections (CRBSI) remains unknown. Aim: To compare solutions with different chlorhexidine (CHG)-based concentrations and povidone-iodine (PVI) in adults with a central venous catheter (CVC) or arterial catheter, and identify an association with the incidence of CRBSI Methods: This study evaluated randomized controlled trials comparing CHG and PVI antiseptic agents in patients aged >18 years with an underlying illness and a CVC or arterial catheter. The primary outcome was CRBSI rate. Network meta-analysis was performed by a frequentist-based approach with multi-variate random effects meta-analysis, and the effect size was expressed as relative risk (RR) with 95% confidence interval (CI). Findings: The search yielded 1511 records, of which five studies (2815 catheters) were included in the network meta-analysis. The risk of CRBSI was significantly lower with 1% CHG-alcohol than with 0.5% CHG-alcohol (RR 0.40, 95% CI 0.16-0.98; high certainty) or 10% PVI-aqueous (RR 0.31, 95% CI 0.15-0.63; high certainty). There was no significant difference in the risk of CRBSI between 1% CHG-alcohol and 2% CHG-aqueous (RR 0.35, 95% CI 0.12-1.04; moderate certainty) or other antiseptic solutions. The hierarchy of efficacy in reducing CRBSI was 1% CHG-alcohol, 0.5% CHG-alcohol, 2% CHG-aqueous and 10% PVIaqueous. Conclusion: Antiseptic agents containing 1% CHG-alcohol were more strongly associated with reduced risk for CRBSI compared with agents containing 0.5% CHG-alcohol or 10% PVIaqueous. (c) 2021 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
引用
收藏
页码:156 / 164
页数:9
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