Incidence of catheter-related bloodstream infections following ultrasound-guided central venous catheterization: a systematic review and meta-analysis

Jun Takeshita; Kazuya Tachibana; Yasufumi Nakajima; Nobuaki Shime

doi:10.1186/s12879-022-07760-1

Incidence of catheter-related bloodstream infections following ultrasound-guided central venous catheterization: a systematic review and meta-analysis

BMC Infect Dis. 2022 Oct 4;22(1):772. doi: 10.1186/s12879-022-07760-1.

Authors

Jun Takeshita¹, Kazuya Tachibana¹, Yasufumi Nakajima^{2

3}, Nobuaki Shime⁴

Affiliations

¹ Department of Anesthesiology, Osaka Prefectural Hospital Organization, Osaka Women's and Children's Hospital, Osaka, Japan.
² Department of Anesthesiology and Intensive Care, Kinki University Faculty of Medicine, Osaka, Japan.
³ Outcomes Research Consortium, Cleveland, OH, USA.
⁴ Department of Emergency and Critical Care Medicine, Institute of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan. shime@koto.kpu-m.ac.jp.

Abstract

Background: Ultrasonographic guidance is widely used for central venous catheterization. Several studies have revealed that ultrasound-guided central venous catheterization increases the rate of success during the first attempt and reduces the procedural duration when compared to the anatomical landmark-guided insertion technique, which could result in protection from infectious complications. However, the effect of ultrasound-guided central venous catheterization on catheter-related bloodstream infections remains unclear. We aimed to conduct a systematic review and meta-analysis to evaluate the value of ultrasound guidance in preventing catheter-related bloodstream infections and catheter colonization associated with central venous catheterization.

Methods: The Cochrane Central Register of Controlled Trials (CENTRAL) and MEDLINE (via PubMed) were searched up to May 9, 2022 for randomized controlled trials (RCTs) comparing ultrasound-guided and anatomical landmark-guided insertion techniques for central venous catheterization. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool for RCTs. A meta-analysis was performed for catheter-related bloodstream infections and catheter colonization, as primary and secondary outcomes, respectively.

Results: Four RCTs involving 1268 patients met the inclusion criteria and were analyzed. Ultrasound-guided central venous catheterization was associated with a slightly lower incidence of catheter-related bloodstream infections (risk ratio, 0.46; 95% confidence interval [CI], 0.16-1.32) and was not associated with a lower incidence of catheter colonization (risk ratio, 1.36; 95% CI, 0.57-3.26).

Conclusion: Ultrasound-guided central venous catheterization might reduce the incidence of catheter-related bloodstream infections. Additional RCTs are necessary to further evaluate the value of ultrasound guidance in preventing catheter-related bloodstream infections with central venous catheterization.

Keywords: Bloodstream infections; Central venous catheterization; Incidence; Ultrasonography.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Catheter-Related Infections* / complications
Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / prevention & control
Catheterization, Central Venous* / adverse effects
Catheterization, Central Venous* / methods
Catheters / adverse effects
Central Venous Catheters* / adverse effects
Humans
Incidence
Sepsis* / etiology
Ultrasonography, Interventional / methods