ORIGINAL ARTICLEThe Risk of Bloodstream Infection in Adults With Different Intravascular Devices: A Systematic Review of 200 Published Prospective Studies
Section snippets
Sources of Data
English-language reports of prospective studies of adults published between January 1, 1966, and July 1, 2005, were identified by MEDLINE search using the following general search strategy: bacteremia [Medical Subject Heading, MeSH] OR septicemia [MeSH] OR bloodstream infection AND the specific type of intravascular device (eg, central venous port). Additional studies of relevance were identified by reviewing the citations of reviews of IVD-related BSI published since 1973.2, 3, 4, 5, 6, 7, 8, 9
RESULTS
Two hundred studies that prospectively examined the risk of IVD-related BSI with peripheral intravenous (IV) catheters and steel needles,22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32 midline catheters,33, 34, 35 arterial catheters for hemodynamic monitoring,36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 PA catheters,37, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61 PICCs,35, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72, 73, 74, 75 nonmedicated CVCs,33, 37, 44, 45, 46, 49, 54, 63, 76, 77, 78
DISCUSSION
An analysis of this type is inherently limited by the heterogeneity of patient populations, protocols for catheter insertion and site care, and manufacturers' devices used in the studies analyzed. Moreover, the criteria used for defining IVD-related BSI varied across studies, although all the studies met published and widely accepted definitions of IVD-related BSI.10, 19, 20 Finally, because of differing degrees of severity of illness, a particular type of device may be associated with a higher
CONCLUSIONS
These data, based on prospective studies in which every IVD was analyzed for evidence of infection using microbiologically based criteria, show that all types of IVDs pose a risk of IVD-related BSI and can be used for benchmarking rates of infection caused by various types of IVDs in use at the present time. Expressing risk of IVD-related BSI per 1000 IVD-days allows for more meaningful estimates of risk than measuring BSIs per 100 IVDs. Since almost all the national effort to date to reduce
Acknowledgments
We are grateful to Richard Holcombe, PhD, for expert statistical guidance and assistance. This analysis of studies done in adults complements a similar analysis of studies done in children.222
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Supported by an unrestricted gift for research from the Oscar Rennebohm Foundation of Madison, Wis.