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VASCULAR SURGERY / SYSTEMATIC REVIEW/META-ANALYSIS
The incidence of catheter-related bloodstream infections in different central venous access devices: a network meta-analysis of randomized controlled trials
1
Department of Nursing,The Affiliated Hospital, Southwest Medical University, Luzhou, Sichuan province, China
2
Department of Medicine, Guang’an Vocational and Technical College, Guang’an, Sichuan province, China
3
Department of Rehabilitation, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
4
Department of Osteoarthropathy, Chongqing Orthopedic Hospital of Traditional Chinese Medicine, Chongqing, China
These authors had equal contribution to this work
Submission date: 2024-06-03
Final revision date: 2024-07-23
Acceptance date: 2024-07-28
Online publication date: 2024-08-05
Corresponding author
Yinchun Liu
Department of Osteoarthropathy Chongqing Orthopedic Hospital of Traditional Chinese Medicine Chongqing, China
Department of Osteoarthropathy Chongqing Orthopedic Hospital of Traditional Chinese Medicine Chongqing, China
Mei Ju
Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou Sichuan province, China
Department of Nursing, The Affiliated Hospital, Southwest Medical University, Luzhou Sichuan province, China
KEYWORDS
catheter-related bloodstream infectionscentral venous access devicesnetwork meta-analysisperipherally inserted central venous catheterstotally implantable venous access portscentral venous catheters
TOPICS
ABSTRACT
Introduction:
Direct paired meta-analyses and network meta-analysis were conducted to compare the incidence of catheter-associated bloodstream infections (CRBSIs) in different types of central venous access devices (CVADs).
Material and methods:
The PubMed, EMBASE, Web of Science, Cochrane, CNKI and CBM databases were systematically searched from inception to May 31, 2024 for randomized controlled trials (RCTs) comparing the incidence of CRBSIs across various types of CVADs. Literature screening, data extraction, and risk bias evaluation were all independently conducted by two individuals. Direct paired meta-analyses and network meta-analysis were performed using RevMan 5.3 and Stata 14.0 software, respectively.
Results:
A total of five studies were included. Paired meta-analyses revealed that the incidence of CRBSIs was lower in the peripherally inserted central catheter (PICC) group compared to the central venous catheter (CVC) group (RR = 0.23, 95% CI (0.13–0.43), p < 0.00001). The incidence of CRBSIs in the PICC group was observed to be lower compared to that in the totally implantable venous access port (TIVAP) group (RR = 0.45, 95% CI (0.23–0.87), p = 0.02). Descriptive analysis revealed a higher incidence of CRBSIs in the CVC group compared to the TIVAP group (RR = 2.97, 95% CI (1.65–5.17), p = 0.0002). The network meta-analysis revealed a significantly lower incidence of CRBSIs in the PICC group compared to the CVC group. However, no statistically significant differences were observed in other comparisons. Based on the cumulative ranking curve test, the incidence of CRBSIs in various CVADs was ranked as follows: PICCs (97.20%) > TIVAPs (50.00%) > CVCs (2.80%).
Conclusions:
The available evidence suggests that PICCs exhibit the lowest incidence of CVADs, followed by TIVAPs. Therefore, PICCs should be prioritized when selecting CVADs.
Direct paired meta-analyses and network meta-analysis were conducted to compare the incidence of catheter-associated bloodstream infections (CRBSIs) in different types of central venous access devices (CVADs).
Material and methods:
The PubMed, EMBASE, Web of Science, Cochrane, CNKI and CBM databases were systematically searched from inception to May 31, 2024 for randomized controlled trials (RCTs) comparing the incidence of CRBSIs across various types of CVADs. Literature screening, data extraction, and risk bias evaluation were all independently conducted by two individuals. Direct paired meta-analyses and network meta-analysis were performed using RevMan 5.3 and Stata 14.0 software, respectively.
Results:
A total of five studies were included. Paired meta-analyses revealed that the incidence of CRBSIs was lower in the peripherally inserted central catheter (PICC) group compared to the central venous catheter (CVC) group (RR = 0.23, 95% CI (0.13–0.43), p < 0.00001). The incidence of CRBSIs in the PICC group was observed to be lower compared to that in the totally implantable venous access port (TIVAP) group (RR = 0.45, 95% CI (0.23–0.87), p = 0.02). Descriptive analysis revealed a higher incidence of CRBSIs in the CVC group compared to the TIVAP group (RR = 2.97, 95% CI (1.65–5.17), p = 0.0002). The network meta-analysis revealed a significantly lower incidence of CRBSIs in the PICC group compared to the CVC group. However, no statistically significant differences were observed in other comparisons. Based on the cumulative ranking curve test, the incidence of CRBSIs in various CVADs was ranked as follows: PICCs (97.20%) > TIVAPs (50.00%) > CVCs (2.80%).
Conclusions:
The available evidence suggests that PICCs exhibit the lowest incidence of CVADs, followed by TIVAPs. Therefore, PICCs should be prioritized when selecting CVADs.
REFERENCES (48)
1.
Yuen HLA, Weinkove R, Ullman A, et al. Central venous access device practice across haematology and oncology centres in Australia and New Zealand: a cross-sectional survey. Int Med J 2023; 53: 426-30.
2.
Laguna JC, Cooksley T, Ahn S, et al. Catheter-related thrombosis (CRT) in patients with solid tumors: a narrative review and clinical guidance for daily care. Supportive Care Cancer 2022; 30: 8577-88.
3.
Yeow M, Soh S, Yap R, et al. A systematic review and network meta-analysis of randomized controlled trials on choice of central venous access device for delivery of chemotherapy. J Vasc Surg 2022; 10: 1184-91.
4.
Cotogni P, Mussa B, Degiorgis C, De Francesco A, Pittiruti M. Comparative complication rates of 854 central venous access devices for home parenteral nutrition in cancer patients: a prospective study of over 169,000 catheter-days. JPEN J Parent Enteral Nutrition 2021; 45: 768-76.
5.
Vashi PG, Virginkar N, Popiel B, Edwin P, Gupta D. Incidence of and factors associated with catheter-related bloodstream infection in patients with advanced solid tumors on home parenteral nutrition managed using a standardized catheter care protocol. BMC Infect Dis 2017; 17: 372.
6.
Paquet F, Morlese J, Frenette C. Use of dry dressings for central venous access devices (CVADs) to decrease central line-associated blood stream infections (CLABSI) in a trauma intensive care unit (ICU). Br J Nursing 2021; 30: S37-42.
7.
Foka M, Nicolaou E, Kyprianou T, et al. Prevention of central line-associated bloodstream infections through educational interventions in adult intensive care units: a systematic review. Cureus 2021; 13: e17293.
8.
Lu H, Hou Y, Chen J, et al. Risk of catheter-related bloodstream infection associated with midline catheters compared with peripherally inserted central catheters: a meta-analysis. Nursing Open 2021; 8: 1292-300.
9.
Rupp ME, Karnatak R. Intravascular catheter-related bloodstream infections. Infect Dis Clin N Am 2018; 32: 765-87.
10.
Cai Y, Zhu M, Sun W, Cao X, Wu H. Study on the cost attributable to central venous catheter-related bloodstream infection and its influencing factors in a tertiary hospital in China. Health Quality Life Outcomes 2018; 16: 198.
11.
Higuera F, Rangel-Frausto MS, Rosenthal VD, et al. Attributable cost and length of stay for patients with central venous catheter-associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hospital Epidemiol 2007; 28: 31-5.
12.
Ziegler MJ, Pellegrini DC, Safdar N. Attributable mortality of central line associated bloodstream infection: systematic review and meta-analysis. Infection 2015; 43: 29-36.
13.
Moureau N, Poole S, Murdock MA, Gray SM, Semba CP. Central venous catheters in home infusion care: outcomes analysis in 50,470 patients. J Vasc Interv Radiol 2002; 13: 1009-16.
14.
Sakai T, Kohda K, Konuma Y, et al. A role for peripherally inserted central venous catheters in the prevention of catheter-related blood stream infections in patients with hematological malignancies. Int J Hematol 2014; 100: 592-8.
15.
Dong YR, Sang BL, Kim GW, Kim JH. A peripherally inserted central catheter is a safe and reliable alternative to short-term central venous catheter for the treatment of trauma patients. J Trauma Injury 2019; 32: 150-6.
16.
Al Raiy B, Fakih MG, Bryan-Nomides N, et al. Peripherally inserted central venous catheters in the acute care setting: a safe alternative to high-risk short-term central venous catheters. Am J Infect Control 2010; 38: 149-53.
17.
Ross VM, Guenter P, Corrigan ML, et al. Central venous catheter infections in home parenteral nutrition patients: Outcomes from Sustain: American Society for Parenteral and Enteral Nutrition’s National Patient Registry for Nutrition Care. Am J Infect Control 2016; 44: 1462-8.
18.
Wong WY, Chan W, Ip SK, et al. Infection rate of hickman catheters versus peripherally inserted central venous catheters in oncology patients. Hong Kong J Radiol 2015; 18: 197-204.
19.
Touré A, Vanhems P, Lombard-Bohas C, et al. Totally implantable central venous access port infections in patients with digestive cancer: incidence and risk factors. Am J Infect Control 2012; 40: 935-9.
20.
Pu YL, Li ZS, Zhi XX, et al. Complications and costs of peripherally inserted central venous catheters compared with implantable port catheters for cancer patients: a meta-analysis. Cancer Nursing 2020; 43: 455-67.
21.
Chopra V, O’Horo JC, Rogers MA, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hospital Epidemiol 2013; 34: 908-18.
22.
Capozzi VA, Monfardini L, Sozzi G, et al. Peripherally inserted central venous catheters (PICC) versus totally implantable venous access device (PORT) for chemotherapy administration: a meta-analysis on gynecological cancer patients. Acta Biomed 2021; 92: e2021257.
23.
Chen S, Liang F, Huang X. The application of VAP and PICC for the older patients. Chin General Pract Nurs 2014; 17: 331-3.
24.
Lian L, Huang J, Yu M. Application of implantable venous access ports and peripherally inserted central catheters in elderly inpatients. Clin Med Engin 2016; 23: 1409-10.
25.
Picardi M, Della Pepa R, Cerchione C, et al. A frontline approach with peripherally inserted versus centrally inserted central venous catheters for remission induction chemotherapy phase of acute myeloid leukemia: a randomized comparison. Clin Lymph Myeloma Leukemia 2019; 19: e184-94.
26.
Taxbro K, Hammarskjöld F, Thelin B, et al. Clinical impact of peripherally inserted central catheters vs implanted port catheters in patients with cancer: an open-label, randomised, two-centre trial. Br J Anaesth 2019; 122: 734-41.
27.
Higgins JP, Welton NJ. Network meta-analysis: a norm for comparative effectiveness? Lancet (London, England) 2015; 386: 628-30.
28.
Fu Q, Liao H, Li Z, Chen X, Zhang X, Di J. Preventive effects of 13 different drugs on colorectal cancer: a network meta-analysis. Arch Med Sci 2023; 19: 1428-45.
29.
Hutton B, Salanti G, Caldwell DM, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med 2015; 162: 777-84.
30.
Moss JG, Wu O, Bodenham AR, et al. Central venous access devices for the delivery of systemic anticancer therapy (CAVA): a randomised controlled trial. Lancet (London, England) 2021; 398: 403-15.
31.
Ray-Barruel G, Xu H, Marsh N, Cooke M, Rickard CM. Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: a systematic review. Infect Dis Health 2019; 24: 152-68.
32.
Wang H, Huang T, Jing J, et al. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis. J Hospital Infect 2010; 76: 1-11.
33.
Dreesen M, Foulon V, Spriet I, et al. Epidemiology of catheter-related infections in adult patients receiving home parenteral nutrition: a systematic review. Clin Nutrition (Edinburgh, Scotland) 2013; 32: 16-26.
34.
Rockholt MM, Agrell T, Thorarinsdottir H, Kander T. Sustained low catheter related infection (CRI) incidence in an observational follow-up study of 9924 catheters using automated data scripts as quality assurance for central venous catheter (CVC) management. Infect Prev Pract 2023; 5: 100273.
35.
Chong HY, Lai NM, Apisarnthanarak A, Chaiyakunapruk N. Comparative efficacy of antimicrobial central venous catheters in reducing catheter-related bloodstream infections in adults: abridged cochrane systematic review and network meta-analysis. Clin Infect Dis 2017; 64 (Suppl_2): S131-40.
36.
Hon K, Bihari S, Holt A, Bersten A, Kulkarni H. Rate of catheter-related bloodstream infections between tunneled central venous catheters versus peripherally inserted central catheters in adult home parenteral nutrition: a meta-analysis. JPEN J Parenteral Enteral Nutr 2019; 43: 41-53.
37.
He E, Ye K, Zheng H. Clinical effect and safety of venous access ports and peripherally inserted central catheters in patients receiving tumor chemotherapy: a systematic review and meta-analysis. Ann Palliat Med 2021; 10: 9105-13.
38.
Narita A, Takehara Y, Maruchi Y, et al. Usefulness of peripherally inserted central catheter port system (PICC-PORT) implantation in the sitting position: a new technique for cases unsuitable for conventional implantation. Japan J Radiol 2023; 41: 108-13.
39.
Shao G, Zhou X, Zhang S, Wu S, Dong Y, Dong Z. Cost-utility analysis of centrally inserted totally implanted access port (PORT) vs. peripherally inserted central catheter (PICC) in the oncology chemotherapy. Front Public Health 2022; 10: 942175.
40.
Liu B, Wu Z, Lin C, Li L, Kuang X. Applicability of TIVAP versus PICC in non-hematological malignancies patients: a meta-analysis and systematic review. PLoS One 2021; 16: e0255473.
41.
Fang S, Yang J, Song L, Jiang Y, Liu Y. Comparison of three types of central venous catheters in patients with malignant tumor receiving chemotherapy. Patient Preference Adherence 2017; 11: 1197-204.
42.
Okada S, Shiraishi A, Yamashiro Y, et al. A retrospective statistical analysis of the late complications associated with central venous port placements. Japan J Radiol 2015; 33: 21-5.
43.
Touré A, Vanhems P, Lombard-Bohas C, Souquet JC, Lauverjat M, Chambrier C. Is diabetes a risk factor for central venous access port-related bloodstream infection in oncological patients? Eur J Clin Microbiol Infect Dis 2013; 32: 133-8.
44.
Machado JD, Suen VM, Figueiredo JF, Marchini JS. Biofilms, infection, and parenteral nutrition therapy. JPEN J Parent Enteral Nutr 2009; 33: 397-403.
45.
Wang D, Liu N, Shi Z, Ding N, Feng C, Zhao W. A meta-analysis of status and risk factors of central venous catheter-associated bloodstream infection in ICU patients. Chin J General Pract 2022; 20: 1954-9.
46.
Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006; 355: 2725-32.
47.
Dibb M, Lal S. Home Parenteral nutrition: vascular access and related complications. Nutr Clin Pract 2017; 32: 769-76.
48.
WHO Guidelines Approved by the Guidelines Review Committee. Guidelines for the prevention of bloodstream infections and other infections associated with the use of intravascular catheters: Part 1: peripheral catheters. Geneva: World Health Organization© World Health Organization 2024.
| eISSN: | 1896-9151 |
| ISSN: | 1734-1922 |
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