Prophylactic antibiotics for preventing early central venous catheter Gram positive infections in oncology patients
Bibliographic record
Abstract
BACKGROUND: Long-term tunnelled central venous catheters (TCVCs) are increasingly used when treating oncology patients. Despite international guidelines on sterile insertion, appropriate catheter maintenance and use, infections still a complication of TCVC. These infections are mainly caused by Gram-positive bacteria. Antimicrobial prevention strategies aimed at these micro-organisms could potentially decrease the majority of TCVC infections. The aim of this review was to evaluate the efficacy of antibiotics in the prevention of early TCVC infections. OBJECTIVES: To determine the efficacy of administering antibiotics prior to insertion of a TCVC with or without vancomycin/heparin flush technique in the first 45 days after insertion of the catheter to prevent Gram-positive catheter-related infections in oncology patients. SEARCH STRATEGY: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) to July 2006. MEDLINE (1966 to 2006) and EMBASE (1966 to 2006). Reference lists from relevant articles were scanned and conference proceedings were hand searched. The authors of eligible studies were contacted to obtain additional information. SELECTION CRITERIA: We selected RCTs which administered prophylactic antibiotics prior to insertion of the TCVC, and RCTs using the combination of an antibiotic and heparin to flush the CVC in oncology patients (both adults and children). DATA COLLECTION AND ANALYSIS: The studies identified were assessed and the data extracted independently by the two authors. Authors were contacted for details of randomization, and a quality assessment was carried out. The analysis was carried out using the standard Cochrane software package, RevMan 4.2. MAIN RESULTS: We included nine trials with a total of 588 patients. Four reported on vancomycin/teicoplanin prior to insertion of the TCVC compared to placebo, and five trials reported on antibiotic flushing combined with heparin, compared to heparin flushing only. The overall effect of administering an antibiotic prior to insertion of the catheter decreases the number of Gram positive TCVC infections (odds ratio [OR] = 0.42, 95% confidence interval (CI) 0.13 to 1.31), this effect is not significant. Flushing the TCVC with antibiotics and heparin proved to be beneficial (OR = 0.43, 95% CI 0.21 to 0.87). For intraluminal colonization the baseline infection rate is 15% which leads to a number needed to treat (NNT) of 13 (95 % CI 5 to 23). AUTHORS' CONCLUSIONS: Flushing of the catheter with a vanco/heparin lock solution leads to a positive overall effect. Depending on the baseline TCVC infection rate it is justified to flush the catheter with a combination of an antibiotic and heparin, if the catheter related infection-rate is high.
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How this classification was reachedexpand
Direct model labels (unvalidated)
Per-model category and study-design labels from the labeling rounds. They are machine output, unvalidated, and the disagreement between models ships as data. No study design here is MEDLINE-validated yet.
| Model arm | Categories | Study design | Confidence |
|---|---|---|---|
| gemma | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Systematic review | low |
| gpt | no category Domain: not available · Genre: Review About the Canadian research system: no · About a Canadian topic: no | Systematic review | high |
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.009 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.013 | 0.002 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedLabeled directly by 2 models reading the full record.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".