Effectiveness of Antiseptic and Antibiotic Use to Prevent Central Line-Associated Bloodstream Infections in ICU Patients: A Systematic Review and Narrative Synthesis of Randomized Clinical Trials.

Objective

The aim of this study was to conduct a narrative synthesis of randomized trials to evaluate the evidence on the effectiveness of antibiotics and antiseptics in preventing central line-associated bloodstream infection (CLABSI) in intensive care unit patients.

Methods

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, and Scopus databases were searched for randomized controlled trials published from 2012 to March 2024. The methodological quality of the included studies was independently evaluated by 2 reviewers using the Critical Appraisal Skills Programme Spanish [Español] appraisal tool. Following data extraction, a narrative synthesis was performed to integrate and interpret the findings across studies. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO).

Results

Nineteen randomized trials were appraised using the Critical Appraisal Skills Programme Spanish [Español] tool, of which 13 high-quality studies (score ≥6) were included in the review. These trials assessed antiseptic (alcohol, chlorhexidine), antibiotic (rifampin), or combined interventions versus standard care. Antiseptic and antibiotic-impregnated catheters and alcohol caps were associated with reduced CLABSI rates, hospital stay, and costs, while evidence for alcohol lock therapy was inconclusive.

Conclusion

This review supports the use of antiseptic and antibiotic-coated catheters as promising measures to prevent CLABSI in critically ill patients. However, caution is warranted with alcohol lock therapy due to limited and conflicting evidence.