Prophylactic antibiotics in the prevention of catheter-associated bloodstream bacterial infection in preterm neonates: a systematic review.

objectiveTo evaluate the efficacy of prophylactic antibiotics in preventing infection associated with central venous catheters in preterm neonates. STUDY

designThe search strategy of the Cochrane Neonatal Review Group was used. The following databases were searched: Medline, Cochrane Central Register of Controlled Trials, CINAHL and EMBASE. In addition, we hand-searched abstracts of Pediatric Academic Societies annual meetings published in Pediatric Research (1990 to July 2007) and Canadian Pediatric Society annual meeting proceedings (1990 to July 2007). No language restrictions were applied. Included were randomized controlled trials of antibiotics given prophylactically to prevent infection in preterm infants (<37 completed weeks) less than 1-month old admitted to neonatal intensive care units. Both centrally or peripherally inserted central venous catheters were included. Assessment of methodological quality and extraction of data for included trials was undertaken independently by two authors. When suitable, data from trials were combined in a meta-analysis.

resultA total of three studies were found which addressed the role of prophylactic antibiotics to prevent catheter-related infection in neonates. Two studies used vancomycin as the prophylactic antibiotic and one study used amoxicillin. The meta-analysis of studies that used vancomycin had shown an absolute risk reduction of infection from 23 to 2.4%, which yields a number needed to treat equal to 5 (P=0.0001). Total duration of catheter stay and mortality, were both similar in the vancomycin and control groups. In the amoxicillin study, catheter-related sepsis was not significantly different between the treatment and control groups (P=0.40). The rate of colonization, however, was significantly higher in the control group (relative risk 0.48; 95% CI 0.12, 1.35). The incidence of necrotizing enterocolitis, intracranial hemorrhage, thrombosis and deaths were not statistically significant between groups.

conclusionProphylactic vancomycin appeared to be effective in preventing catheter-related sepsis in preterm neonates. The potential risks, however, of the emergence of resistance because of prophylactic antibiotics, and their continued effectiveness, need further evaluation, before routine use can be recommended.