中心静脉导管相关或相关血流感染儿童的导管抢救策略:系统回顾和荟萃分析。

D Buonsenso, G Salerno, G Sodero, F Mariani, L Pisapia, C Gelormini, M Di Nardo, P Valentini, G Scoppettuolo, D G Biasucci
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引用次数: 0

摘要

背景:儿童中心静脉导管相关或相关血流感染(CRBSI或CLABSI)的最佳管理尚未确定。目的:评价儿科患者导管保留策略的成功率。方法:从医学数据库和文献参考文献中检索研究。收集了两种治疗方法的临床结果相关数据:单独使用全系统抗生素或与抗菌锁定疗法(ALT)联合使用。比值比(ORs)和95%置信区间(ci)由混合logistic效应模型计算。异质性采用I2统计量进行总结。采用Egger’s回归检验和漏斗图分析发表偏倚。结果:在345篇确定的出版物中,19篇符合纳入标准(总共914篇尝试挽救策略)。为了成功挽救导管,在CRBSI中,添加ALT优于单独使用全身抗生素(OR: -0.40;95% ci: -1.41, 0.62): 77% (95% ci: 69, 85;I2 = 42.5%;P = 0.12)和68%的成功率(95% CI: 59,77;I2 = 0;P < 0.05)。与单独使用全身抗生素相比,使用ALT的研究中CRBSI复发率较低:5% (95% CI: 0,13;I2 = 59.7%;P = 0.03),复发率为18% (95% CI: 9,28;I2 = 0;P < 0.05)。抗生素锁和乙醇锁的复发率都很低。在CLABSI中,与仅全系统抗生素相比,添加ALT没有明显的益处(OR: -0.81;95% ci: -0.80, 2.43)。结论:根据病因,在全身抗生素中添加抗菌锁液可能有利于儿科CRBSI患者成功挽救导管,而对于CLABSI,在全身抗生素中添加或不添加抗菌锁液没有统计学上的显著差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Catheter salvage strategies in children with central venous catheter-related or -associated bloodstream infections: a systematic review and meta-analysis.

Background: Optimal management of central venous catheter-related, or -associated, bloodstream infections (CRBSI or CLABSI) in children is not established.

Aim: To evaluate success of catheter salvage strategies in paediatric patients.

Methods: Studies were retrieved from medical databases and article reference lists. Data were collected relating to clinical outcomes of two treatments: systemic antibiotics alone or in association with antimicrobial lock therapy (ALT). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated from a mixed logistic effects model. Heterogeneity was summarized using I2 statistics. Publication bias was investigated by Egger's regression test and funnel plots.

Findings: From 345 identified publications, 19 met inclusion criteria (total of 914 attempted salvage strategies). To achieve successful catheter salvage, in CRBSI the addition of ALT was superior to systemic antibiotics alone (OR: -0.40; 95% CI: -1.41, 0.62): 77% (95% CI: 69, 85; I2 = 42.5%; P = 0.12) and 68% of success (95% CI: 59, 77; I2 = 0; P < 0.05), respectively. CRBSI recurrence was less common in studies that used ALT compared with systemic antibiotics alone: 5% (95% CI: 0, 13; I2 = 59.7%; P = 0.03) and 18% of recurrence (95% CI: 9, 28; I2 = 0; P < 0.05), respectively. Recurrences were low with both antibiotic locks and ethanol lock. No clear benefits of ALT addition compared to systemic antibiotic only were found in CLABSI (OR: -0.81; 95% CI: -0.80, 2.43).

Conclusion: The addition of an antimicrobial lock solution to systemic antibiotic may be beneficial for successful catheter salvage in paediatric patients with CRBSI, depending on aetiology, whereas no statistically significant difference between systemic antibiotic with or without addition of an antimicrobial lock solution was found regarding CLABSI.

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