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