Prevención de infecciones nosocomiales mediante impregnación antimicrobiana del catéter venoso central

María Pérez-Corral; María Montserrat Llamas-Mata; Antonio Luzón-Barrilado; Eva Benito-Ruiz; Roberto Alijarde-Lorente; David Manuel Serrano-Barona

María Pérez-Corral Hospital Universitario Miguel Servet (Zaragoza, España)
María Montserrat Llamas-Mata Hospital Universitario Reina Sofía (Córdoba, España)
Antonio Luzón-Barrilado Hospital Vithas La Salud (Granada, España)
Eva Benito-Ruiz Hospital Universitario Miguel Servet (Zaragoza, España)
Roberto Alijarde-Lorente Hospital Obispo Polando (Teruel, España)
David Manuel Serrano-Barona Hospital Universitario Miguel Servet (Zaragoza, España)

Palabras clave: Catéter venoso central, Infección, Antimicrobiano, Cuidados críticos

Key-words: Central venous catheter, Infection, Antimicrobial, Critical care

Resumen

Objetivo principal: Evaluar si el uso de catéter venoso central (CVC) impregnado en antimicrobiano es útil para la reducción de la bacteriemia relacionada con el catéter en pacientes ingresados en la Unidad de Cuidados Intensivos (UCI), e identificar el antimicrobiano más efectivo. Metodología: Se realizó una revisión sistemática en Bases Datos (CINAHL, PUBMED, CUIDEN, EMBASE, LILACS y SCIELO). Incluidos artículos de 2009 a 2017, inglés y español, que fuesen ensayos clínicos aleatorizados e incluyeran pacientes de UCI con CVC impregnado comparado con CVC convencional. Se evaluó la calidad metodológica de los artículos mediante la herramienta CASPE. Resultados principales: De los 8 estudios, 4 mostraron significancia en cuanto al uso de CVC impregnados para la reducción de infecciones relacionadas con el catéter. Dentro de los antimicrobianos usados, la minociclina-rifampicina muestra la mayor efectividad. Conclusión principal: El uso de CVC impregnado, puede ser efectivo en la reducción de infecciones en UCI. Dentro de las limitaciones de este tipo de catéter, a mayor número de luces y tiempo de mantenimiento de CVC, menor efectividad antimicrobiana.

Abstract

Objective: To evaluate if the use of central venous catheter (CVC) impregnated in antimicrobial is useful for the reduction of catheter-related bacteraemia (CRB) in patients of Intensive Care Unit (ICU) and who of thes is the highest. Methods: A Systematic Review: CINAHL, PUBMED, CUIDEN, EMBASE, LILACS and SCIELO. Were included Randomized Controlled Trials between 2009 – 2017, including patients coming from ICU with an impregnated CVC, compared with traditional CVC. The methodological quality of each paper was evaluated with the tool CASPE. Results: 8 studies were included. After the use of CVC impregnated, 4 studies were statistically significant and 4 could not be concluded with significance. The minocycline-rifampicin is the highest antimicrobial. Conclusions: The use of CVC impregnated, associated with other measures, could be an effective action for the reduction of infections or prevention of nosocomial infections in ICU patients. Greater time and more lumens is related with less effectiveness.

Bibliografía

Ruiz-Giardin JM, Noguerado Asensio A. Bacteriemias. Med Interna. 2005;22(105).

Saint S, Veenstra DL, Lipsky BA. The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful? Infect Control Hosp Epidemiol. 2000;21(6):375-80.

Cicalini S, Palmieri F, Petrosillo N. Clinical review: new technologies for prevention of intravascular catheter-related infections. Crit Care Lond Engl. 2004;8(3):157-62.

Sociedad Española de Medicina Preventiva Salud Pública e Higiene EC for DP and C. Estudio de Prevalencia de las Infecciones Nosocomiales en España (EPINE). 2013;(Monograph).

Ministerio de Sanidad SS e I [Sede W. Madrid: Ministerio de Sanidad, Servicios Sociales e Igualdad. Plan de Calidad para el Sistema Nacional de Salud [1 pantalla]. 2014.

Ministerio de Salud Servicios Sociales e Igualdad OM de la SS. Protocolo de prevención de las bacteriemias relacionadas con los catéteres venosos centrales (BRC) en las UCI españolas. Anexo 21. 2009;(Monograph).

O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, et al. Summary of Recommendations: Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis. 2011;52(9):1087-99.

McDonnell G, Russell AD. Antiseptics and disinfectants: activity, action, and resistance. Clin Microbiol Rev. 1999;12(1):147-79.

Raad II, Hanna HA. Intravascular catheter-related infections: new horizons and recent advances. Arch Intern Med. 2002;162(8):871-8.

Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. Cochrane Collab [Internet]. 2010 [citado 19 de marzo de 2017]; Disponible en: www.cochrane-handbook.org

Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA. 2000;283(15):2008-12.

Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.

Institute of Health Sciences de Oxford. Critical Appraisal Skills Programme version español CASPe. 2011; Disponible en: http:// redcaspe.org/drupal/?q=node/29.

Mer M, Duse AG, Galpin JS, Richards GA. Central venous catheterization: a prospective, randomized, double-blind study. Clin Appl Thromb Off J Int Acad Clin Appl Thromb. 2009;15(1):19-26.

Arvaniti K, Lathyris D, Clouva-Molyvdas P, Haidich AB, Mouloudi E, Synnefaki E, et al. Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study. Crit Care Med. 2012;40(2):420-9.

Antonelli M, De Pascale G, Ranieri VM, Pelaia P, Tufano R, Piazza O, et al. Comparison of triple-lumen central venous catheters impregnated with silver nanoparticles (AgTive(R)) vs conventional catheters in intensive care unit patients. J Hosp Infect. 2012;82(2):101-7.

Camargo LF, Marra AR, Büchele G, Sogayar AM, Cal RG, de Sousa J, et al. Double-lumen central venous catheters impregnated with chlorhexidine and silver sulfadiazine to prevent catheter colonisation in the intensive care unit setting: a prospective randomised study. J Hosp Infect. 2009;72(3):227-33.

Lorente L, Lecuona M, Jiménez A, Raja L, Cabrera J, Gonzalez O, et al. Chlorhexidine-silver sulfadiazine– or rifampicin-miconazole–impregnated venous catheters decrease the risk of catheter-related bloodstream infection similarly. Am J Infect Control. 2016;44(1):50-3.

Walz JM, Avelar RL, Longtine KJ, Carter KL, Mermel LA, Heard SO. Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization. Crit Care Med. 2010;38(11):2095-102.

Lorente L, Lecuona M, Ramos MJ, Jiménez A, Mora ML, Sierra A. Rifampicin–miconazole-impregnated catheters save cost in jugular venous sites with tracheostomy. Eur J Clin Microbiol Infect Dis. 2012;31(8):1833-6.

Lorente L, Lecuona M, Ramos MJ, Jiménez A, Mora ML, Sierra A. Lower associated costs using rifampicin-miconazole‒impregnated catheters compared with standard catheters. Am J Infect Control. 2011;39(10):895-7.

Cherry-Bukowiec JR, Denchev K, Dickinson S, Chenoweth CE, Zalewski C, Meldrum C, et al. Prevention of Catheter-Related Blood Stream Infection: Back to Basics? Surg Infect. 2011;12(1):27-32.

O’Grady NP, Chertow DS. Managing bloodstream infections in patients who have short-term central venous catheters. Cleve Clin J Med. 2011;78(1):10-7.

Lorente L, Lecuona M, Jiménez A, Santacreu R, Raja L, Gonzalez O, et al. Chlorhexidine-silver sulfadiazine-impregnated venous catheters save costs. Am J Infect Control. 2014;42(3):321-4.

Wang H, Huang T, Jing J, Jin J, Wang P, Yang M, et al. Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis. J Hosp Infect. 2010;76(1):1-11.

Lai NM, Chaiyakunapruk N, Lai NA, O’Riordan E, Pau WSC, Saint S. Catheter impregnation, coating or bonding for reducing central venous catheter-related infections in adults. En: The Cochrane Collaboration, editor. Cochrane Database of Systematic Reviews [Internet]. Chichester, UK: John Wiley & Sons, Ltd; 2016 [citado 1 de abril de 2017]. Disponible en: http://doi.wiley.com/10.1002/14651858.CD007878.pub3

Casey AL, Mermel LA, Nightingale P, Elliott TS. Antimicrobial central venous catheters in adults: a systematic review and meta-analysis. LancetInfectious Dis. 2008;8(12):763-76.

Falagas ME, Fragoulis K, Bliziotis IA, Chatzinikolaou I. Rifampicin-impregnated central venous catheters: a meta-analysis of randomized controlled trials. J Antimicrob Chemother. 2007;59(3):359-69.

Niel-Weise BS, Stijnen T, van den Broek PJ. Anti-infective-treated central venous catheters: a systematic review of randomized controlled trials. Intensive Care Med. 2007;33(12):2058-68.

Gilbert RE, Harden M. Effectiveness of impregnated central venous catheters for catheter related blood stream infection: a systematic review. Curr Opin Infect Dis. 2008;21(3):235-45.

McConnell SA, Gubbins PO, Anaissie EJ. Do antimicrobial-impregnated central venous catheters prevent catheter-related bloodstream infection? Clin Infect Dis Off Publ Infect Dis Soc Am. 2003;37(1):65-72.

Niel-Weise BS, Stijnen T, van den Broek PJ. Anti-infective-treated central venous catheters for total parenteral nutrition or chemotherapy: a systematic review. J Hosp Infect. 2008;69(2):114-23.

Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, et al. A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group. N Engl J Med. 1999;340(1):1-8.

Ramritu P, Halton K, Collignon P, Cook D, Fraenkel D, Battistutta D, et al. A systematic review comparing the relative effectiveness of antimicrobial-coated catheters in intensive care units. Am J Infect Control. 2008;36(2):104-17.

Prevención de infecciones nosocomiales mediante impregnación antimicrobiana del catéter venoso central

Prevention of nosocomial infections with antimicrobial impregnation of central venous catheter

Resumen

Abstract

Bibliografía