We review the current evidence on incidence of central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients, and outline pathways for prevention and intervention.
An extensive electronic search was carried out on the relevant databases. Articles were considered suitable for inclusion if they investigated catheter colonization and catheter-related bloodstream infection. Two independent reviewers were engaged in selecting appropriate articles in line with the above protocol. Our search protocol retrieved 8 articles published from 1999 to 2011.
Types of study to be included
Original research studies and case studies/reports.
Condition or domain being studied
Central and peripheral venous catheter-related bloodstream infections in critically ill surgical patients.
Articles were considered suitable for inclusion if they investigated catheter colonization and catheter-related (CVC and/or PICC) bloodstream infection in critically ill surgical patients.
An extensive electronic search was carried out on the relevant databases including PubMed, PubMed Central, MEDLINE, EMBASE, Google Scholar and Science Direct. Due to the specificity of the review, various terms and Boolean operators were included in the search to ensure that relevant studies were not missed due to the search criteria. These terms included: “central venous catheter/ line” (CVC), “peripheral venous catheter/line” (PVC), “peripherally inserted central catheter” (PICC), “surgical intensive care”, “critically ill surgical patient”, “blood stream infection”, “intra-vascular catheter”. This resulted in 47 studies. To supplement our search, we also reviewed the references of the above studies to identify additional articles that our search criteria may not have included. After our initial recruitment of studies, we excluded review papers, those that focused on medical patients and those dated pre-1990.
Although our search protocol may not have yielded an exhaustive list we have identified a key deficiency in the literature namely a paucity of studies investigating the incidence of CVC- and PICC-related bloodstream infection in exclusively critically ill surgical populations.
In summary, the diverse definitions for the diagnosis of CRBSI along with the vastly different sample size and extremely small PICC population size has, predictably, yielded inconsistent findings. Our current understanding is still limited; the studies we have identified do point us towards some tentative understanding that the CVC/PICC performance with regards to CRBSI remains inconclusive
Central and peripheral venous catheter-related bloodstream infections.
Outcome following central and peripheral venous catheter-related bloodstream infections.
Data extraction, (selection and coding)
Our search protocol retrieved 8 articles published from 1999 to 2011. Outcomes relating to CVC, including colonization and CRBSI, were investigated in six studies; four of which were prospective cohort studies, one prospective longitudinal study and one retrospective cohort study. Outcomes relating only to PICCs were reported in one prospective randomized trial. We found only one study of retrospective cohort in design, which compared CVC- and PICC-related complications in surgical intensive care units.
Risk of bias (quality) assessment
A key difficulty in the assessment of risk of bias or quality is the obstacle provided by incomplete reporting. While the emphasis should be on the risk of bias in the actual design and conduct of a study, it can be tempting to resort to assessing the adequacy of reporting. We used scoring in scales and often based on whether something was reported rather than whether it was done appropriately in the study.
Strategy for data synthesis
The data to be used will be aggregate. Narrative (descriptive) synthesis is planned.
Analysis of subgroups or subsets
Through oral communications at national and international meetings as well as publications.
Contact details for further information
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London W5 3DD
Organisational affiliation of the review
Leeds Institute of Molecular Medicine
Dr Waseem Jerjes, Leeds Institute of Molecular Medicine Mr Mohamed Ugas, Barts and the London School of Medicine and Dentistry Mr Hyongyu Cho, Barts and the London School of Medicine and Dentistry Mr Gregory Trilling, Barts and the London School of Medicine and Dentistry Miss Zainab Tahir, Barts and the London School of Medicine and Dentistry Mr Humaera Raja, Barts and the London School of Medicine and Dentistry Mr Sami Ramadan, University College London Medical School Professor Peter Giannoudis, Leeds Institute of Molecular Medicine
Formal screening of search results against eligibility criteria
Risk of bias (quality) assessment
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