Do Antimicrobial Peripherally Inserted Central Catheters Reduce the Risk of Central Line-Associated Bloodstream Infection? A Systematic Review and Meta-Analysis

Background: While peripherally inserted central catheters (PICCs) are important in caring for patients, they are associated with central line-associated bloodstream infection (CLABSI). Antimicrobial PICCs are novel devices that may reduce the risk of CLABSI, but data are conflicting.  

Methods: We performed a systematic review and meta-analysis to evaluate whether antimicrobial PICCs reduce the risk of CLABSI. Relevant studies were identified by searching four databases (MEDLINE via Ovid, EMBASE, CINHAL and Web of Science) from inception to March 2015. Additional studies and data were identified through hand searches of bibliographies and direct inquires to authors. Studies that reported CLABSI outcomes between antimicrobial PICCs vs. non-coated central venous catheters were included. Two reviewers independently assessed study eligibility and abstracted data; discrepancies were resolved via consensus. Summary odds ratios (ORs) were calculated using a random effects meta-analysis.

Results: Of 503 citations identified, four studies (two retrospective; one quasi-experimental and one prospective cohort study) involving 925 patients met eligibility criteria. Studies included adult and pediatric patients from intensive care, long-term care and general ward settings. The overall prevalence of CLABSI was 5.9% (55/925) with an average catheter dwell time of 66 days. Two studies utilized minocycline-rifampin PICCs and two included chlorhexidine-coated PICCs. Pooled data revealed that antimicrobial PICCs were associated with a significant decrease in CLABSI compared to non-coated central venous catheters (OR 0.11, 95% confidence interval [CI] 0.04–0.31, P <0.001. No statistical heterogeneity was appreciated in the pooled analysis (I²=0%, P=0.44). Significant differences in CLABSI reduction between minocycline-rifampin and chlorhexidine-coated devices were not observed (OR=0.11 vs. OR=0.08, p=0.89 respectively).

Conclusions: Available data suggests that antimicrobial PICCs are associated with a significant reduction in CLABSI. However, the observational nature of the data, comparison to non-PICC devices and additional costs of these devices limit generalizability. Randomized trials appear necessary before widespread use can be recommended.