Table 1 Strategies in the prevention of catheter-related bloodstream infections

Care and management bundles [12, 15–21]

Education

Skin antisepsis

Daily

reassessment of indication

Preventing contamination

None

Patients in pediatric ICUs [15–18, 21]

Pediatric cardiac ICU [20]

Outcome reductions: 70 to 83%

No assessment of individual steps

High baseline infection rates

2b

Impregnated dressing [59–61]

Chlorhexidine

Preventing contamination

Reported toxicity in children

Adults in ICUs [59] Neonates [60, 61]

Hazard ratio = 0.402 (95% CI = 0.186 to 0.868) for CRBSI

compared with conventional dressing

Only two pediatric studies (neonates) [60, 61]

(1b)b

Antibiotic-impregnated catheters [58, 60–62]

Minocycline/rifampicin

Preventing biofilm formation

Antibiotic resistance

All patients in RCTs requiring a CVC [58, 62]

Adults requiring a CVC, >50% treated in ICUs [60]

RR = 0.26 to 0.39 for CRBSI compared with standard catheter

Unknown cost-benefit in children

Limited availability for pediatric use

(1a)b

Non-antibiotic-impregnated catheters [58, 60, 62, 63]

Heparin coating

Preventing biofilm formation

Resistance Anaphylaxis

Pediatric ICU [63]

Hazard ratio = 0.11 (95% CI = 0.04 to

0.31) compared with standard catheter

Unknown cost-benefit in children

Limited availability for pediatric use

1b (1a)b

Chlorhexidine- silver sulfadiazine coating

All patients in RCTs requiring a CVC [58, 62]

Adults requiring a CVC, >50% treated

in ICUs [60]

Conflicting interpretations of results

-

Antibiotic lock [39, 40]

Vancomycine; minocycline; gentamycine; cefotaxim

High antibiotic concentrations

Penetrating and disrupting biofilm

Antibiotic resistance

Adults and children with end-stage renal disease undergoing hemodialysis [39]

RR = 0.37/day (95% CI = 0.30 to 0.47)

compared with heparin (systematic review of all antibiotic locks; adult)

Long indwelling times may compromise feasibility

Only one predominantly pediatric study with questionable choice of outcome

1b (1a)b

Vancomycine

Patients with various

malignancies and single lumen CVC, predominantly children [40]

Significantly reduced number of febrile and bacteremic

episodes among non-neutropenic cancer patients

-

Non-antibiotic lock [37, 51, 52, 117, 118]

Chelating agents

Protein denaturation

Disruption of biofilm

Systemic adverse events

Catheter damage

Adults with acute renal failure undergoing hemodialysis in ICUs [37]

Chelating agents: no significant results. Only adult studies

Long indwelling times may compromise feasibility

(1b)b

Taurolidine- citrate

Children with various malignancies

requiring a CVC [51]

Taurolidine-citrate: significantly reduced risk of CRBSI

1b

Ethanol

Pediatric patients receiving PEN [52]

Adult, hematologic patients [117, 118]

Ethanol: no reduction in CRBSI

1b