Summary of findings for the main comparison. Impregnated catheters versus non‐impregnated catheters for reducing the risk of central venous catheter‐related infections in adults.
| Impregnated catheters versus non‐impregnated catheters for reducing the risk of central venous catheter related infections in adults | ||||||
| Patient or population: adult patients who required central venous catheters Settings: hospital setting (medical and/or surgical intensive care unit, oncology, general wards or settings that catered for long‐term total parenteral nutrition) Intervention: antimicrobial‐impregnated central venous catheters | ||||||
| Outcomes | Illustrative comparative risks* (95% CI) | Relative effect (95% CI) | No of participants (studies) | Quality of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Control | Impregnated catheters | |||||
| Clinically‐diagnosed sepsis Identified by clinical, biochemical and/or microbiological methods | Study population1 | RR 1.00 (0.88 to 1.13) | 3686 (12 studies) | ⊕⊕⊕⊝ moderate2 | ||
| 172 per 1000 | 172 per 1000 (152 to 195) | |||||
| Low1 | ||||||
| 7 per 1000 | 7 per 1000 (6 to 8) | |||||
| High1 | ||||||
| 443 per 1000 | 443 per 1000 (390 to 501) | |||||
| Catheter‐related blood stream infection (CRBSI) Identified by catheter culture and clinical features +/‐ haematological and biochemical parameters | Study population1 | RR 0.62 (0.52 to 0.74) | 10405 (42 studies) | ⊕⊕⊕⊕ high | ||
| 57 per 1000 | 35 per 1000 (29 to 41) | |||||
| Low1 | ||||||
| 13 per 1000 | 8 per 1000 (7 to 9) | |||||
| High1 | ||||||
| 286 per 1000 | 174 per 1000 (146 to 209) | |||||
| All‐cause mortality | Study population1 | RR 0.92 (0.80 to 1.07) | 2643 (10 studies) | ⊕⊕⊕⊕ high | ||
| 176 per 1000 | 155 per 1000 (132 to 185) | |||||
| Low1 | ||||||
| 77 per 1000 | 68 per 1000 (58 to 81) | |||||
| High1 | ||||||
| 420 per 1000 | 370 per 1000 (315 to 441) | |||||
| Catheter colonization Identified by catheter culture (microbiological methods) | Study population1 | RR 0.67 (0.59 to 0.76) | 9910 (43 studies) | ⊕⊕⊕⊝ moderate3 | ||
| 270 per 1000 | 178 per 1000 (157 to 203) | |||||
| Low1 | ||||||
| 121 per 1000 | 80 per 1000 (70 to 91) | |||||
| High1 | ||||||
| 714 per 1000 | 471 per 1000 (414 to 536) | |||||
| Catheter‐related local infection Identified by catheter culture (microbiological methods) and clinical features | Study population1 | RR 0.84 (0.66 to 1.07) | 2688 (12 studies) | ⊕⊕⊕⊝ moderate4 | ||
| 90 per 1000 | 76 per 1000 (60 to 97) | |||||
| Low1 | ||||||
| 20 per 1000 | 17 per 1000 (13 to 21) | |||||
| High1 | ||||||
| 171 per 1000 | 144 per 1000 (113 to 183) | |||||
| Adverse effects (combined) Identified by clinical assessment | Study population1 | RR 1.09 (0.94 to 1.27) | 3003 (10 studies) | ⊕⊕⊕⊕ high | ||
| 142 per 1000 | 155 per 1000 (134 to 180) | |||||
| Low1 | ||||||
| 46 per 1000 | 50 per 1000 (43 to 58) | |||||
| High1 | ||||||
| 224 per 1000 | 244 per 1000 (211 to 284) | |||||
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; RR: Risk ratio | ||||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||||
1 We provided three typical risk values for each outcome included in this table, namely, 'low risk', 'high risk' and average control risk. We chose the second lowest (non‐zero) control risk value from the included studies as 'low risk', and second highest control risk value as 'high risk', as recommended by the GRADE working group. 2 Publication bias is suspected as the funnel plot for this outcome shows asymmetry, with an apparent absence of smaller studies in which the outcome favours non‐impregnated catheters. We downgraded the quality of evidence by one level.
3 There was substantial heterogeneity in the results of the included studies for this outcome, as indicated by an I2 statistic of 64%. We downgraded the quality of evidence by one level. 4 The 95% confidence interval of the pooled estimate ranges from 0.66 to 1.07, which is not narrow enough for a confident judgment of the effect size. We downgraded the quality of evidence by one level.