Systemic Antibiotic Prophylaxis

Recommendation

  1. Do not administer systemic antimicrobial prophylaxis routinely before insertion or during use of an intravascular catheter to prevent catheter colonization or CRBSI [1].

Background

Several studies have examined the role of systemic antibiotic prophylaxis in prevention of catheter-related infection. A recent meta-analysis reviewed these studies in oncology patients [1]. Four studies used a prophylactic glycopeptide prior to catheter insertion. However, heterogeneity in these studies precludes making any conclusion regarding efficacy. 

In a study examining the effect of ongoing oral prophylaxis with rifampin and novobiocin on catheter-related infection in cancer patients treated with interleukin-2 [2], a reduction in CRBSI was observed, even though 9 of 26 subjects (35%) discontinued the prophylactic antibiotics due to side effects or toxicity. In non-oncology patients, no benefit was associated with vancomycin administration prior to catheter insertion in 55 patients undergoing catheterization for parenteral nutrition [3]. Similarly, extending perioperative prophylactic antibiotics in cardiovascular surgery patients did not reduce central venous catheter colonization [4]. A recent Cochrane review of prophylactic antibiotics in neonates with umbilical venous catheters concluded that there is insufficient evidence from randomized trials to support or refute the use of prophylactic antibiotics [5]. 

Late onset neonatal sepsis is often due to coagulase negative staphylococci and is thought to frequently stem from infected central venous catheters. Five trials involved a total of 371 neonates comparing vancomycin by continuous infusion via parenteral nutrition or intermittent dosing, and placebo. The infants treated with vancomycin experienced less sepsis (RR .11; 95% CI .05-.24) and less sepsis due to coagulase negative staphylococci (RR .33; 95% CI .19–.59) [6]. However, mortality and length of stay were not significantly different between the two groups. There were insufficient data to evaluate the risk of selection for vancomycin resistant organisms.

  1. van de Wetering MD, van Woensel JBM. Prophylactic antibiotics for preventing early central venous catheter Gram positive infections in oncology patients. Cochrane Database of Systematic Reviews 2007; Issue 1. Art. No.: CD003295. DOI: 10.1002/ 14651858.CD003295.pub2.
  2. Raad II, Hachem RY, Abi-Said D, et al. A prospective crossover randomized trial of novobiocin and rifampin prophylaxis for the prevention of intravascular catheter infections in cancer patients treated with interleukin-2. Cancer 1998; 82:403–11.
  3. McKee R, Dunsmuir R, Whitby M, Garden OJ. Does antibiotic prophylaxis at the time of catheter insertion reduce the incidence of catheter-related sepsis in intravenous nutrition? J Hosp Infect 1985; 6:419–25.
  4. Sandoe JA, Kumar B, Stoddart B, et al. Effect of extended perioperative antibiotic prophylaxis on intravascular catheter colonization and infection in cardiothoracic surgery patients. J Antimicrob Chemother 2003; 52:877–9.
  5. Inglis GDT, Jardine LA, Davies MW. Prophylactic antibiotics to reduce morbidity and mortality in neonates with umbilical artery catheters. Cochrane Database of Systematic Reviews 2007; Issue 4. Art. No.: CD004697. DOI: 10.1002/14651858.CD004697.pub3.
  6. Craft AP, Finer N, Barrington KJ. Vancomycin for prophylaxis against sepsis in preterm neonates. Cochrane Database of Systematic Reviews 2000; Issue 1. Art. No.: CD001971. DOI: 10.1002/14651858. CD001971.
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