BACKGROUND:Catheter-related infections cause morbidity and mortality in patients undergoing hemodialysis. PURPOSE:To examine whether topical or intraluminal antibiotics reduce catheter-related bloodstream infection compared with no antibiotic therapy in adults undergoing hemodialysis. DATA SOURCES:Electronic databases, trial registries, bibliographies, and conference proceedings up to October 2007, with no language restrictions. STUDY SELECTION:Two reviewers independently selected randomized, controlled trials using topical or intraluminal antibiotics for prophylaxis of infection in adults with catheters who are undergoing hemodialysis. DATA EXTRACTION:Two independent reviewers assessed studies for inclusion, quality, and extracted data. DATA SYNTHESIS:Fixed-effects models were used to estimate pooled rate ratios for outcomes. Topical antibiotics reduced the rate of bacteremia (rate ratio, 0.22 [95% CI, 0.12 to 0.40]; 0.10 vs. 0.45 case of bacteremia per 100 catheter-days), exit-site infection (rate ratio, 0.17 [CI, 0.08 to 0.38]; 0.06 vs. 0.41 case of infection per 100 catheter-days), need for catheter removal, and hospitalization for infection. Intraluminal antibiotics reduced the rate of bacteremia (rate ratio, 0.32 [CI, 0.22 to 0.47]; 0.12 vs. 0.32 case of bacteremia per 100 catheter-days) and need for catheter removal. Intraluminal antibiotics did not significantly reduce the rate of exit-site infection, and no hospitalization data were available for these agents. LIMITATIONS:The evidence base included only 16 trials, and most had less than 6 months of follow-up. Only one third of studies were blinded. Publication bias was evident. CONCLUSION:Both topical and intraluminal antibiotics reduced the rate of bacteremia as well as the need for catheter removal secondary to complications. Whether these strategies will lead to antimicrobial resistance and loss of efficacy over longer periods remains unclear.

译文

背景:与导管相关的感染会导致血液透析患者的发病和死亡。
目的:探讨在接受血液透析的成年人中,与不使用抗生素治疗相比,局部或腔内抗生素是否可减少与导管相关的血液感染。
数据来源:截止到2007年10月的电子数据库,审判登记簿,参考书目和会议记录,没有语言限制。
研究选择:两名评价者独立选择了局部或腔内抗生素治疗患有血液透析的成人导管感染的随机对照试验。
数据提取:两名独立的审阅者对研究的纳入,质量和提取的数据进行了评估。
数据综合:固定效应模型用于估计结果的合并比率。外用抗生素降低了菌血症的发生率(比率,0.22 [95%CI,0.12至0.40]; 0.10对0.45例细菌血症,每100个导管日),出部位感染(比率,0.17 [CI,0.08至[0.38];每100个导管日感染0.06例vs.0.41例),需要拔除导管并进行感染住院。腔内抗生素降低了菌血症发生率(比率比率,每100个导管日为0.32 [CI,0.22至0.47]; 0.12比0.32例菌血症),并且需要移除导管。腔内抗生素并没有显着降低出口部位感染的发生率,也没有这些药物的住院数据。
局限性:证据仅包括16个试验,并且大多数随访时间少于6个月。只有三分之一的研究是盲目的。出版偏见显而易见。
结论:局部和腔内抗生素均可降低菌血症发生率,并减少因并发症而需要拔除导管的情况。这些策略是否会在较长时期内导致抗药性和药效下降尚不清楚。

+1
+2
100研值 100研值 ¥99课程
检索文献一次
下载文献一次

去下载>

成功解锁2个技能,为你点赞

《SCI写作十大必备语法》
解决你的SCI语法难题!

技能熟练度+1

视频课《玩转文献检索》
让你成为检索达人!

恭喜完成新手挑战

手机微信扫一扫,添加好友领取

免费领《Endnote文献管理工具+教程》

微信扫码, 免费领取

手机登录

获取验证码
登录