Data ultima revisione del testo:gennaio 2010 Data creazione: gennaio 2010 Redatto da: P. Baldo ESTRATTO dalla Review Cochrane: Interventions other than anticoagulants and systemic antibiotics
for prevention of central venous catheter- related infections in
children with cancer.
Copyright © 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd.
Cochrane Intervention Review, 2010 Citation: Arora RS, Roberts R, Eden TOB, Pizer B. Interventions other than anticoagulants and systemic antibiotics for prevention of central venous catheter‐related infections in children with cancer. Cochrane Database of Systematic Reviews 2010, Issue 12. Art. No.: CD007785. DOI: 10.1002/14651858.CD007785.pub2. Copyright © 2010 The Cochrane Collaboration. Published by JohnWiley & Sons, Ltd. SINTESI In linguaggio semplice (P L A I N L A N G U A G E S U M M A R Y) Treatment of children with cancer often involves giving drugs, fluids and blood products through veins. In addition, small amounts of blood from the child are frequently needed for testing in the laboratory. All this can be achieved by inserting a central venous catheter (CVC) which is a small tube inserted via skin into the blood vessel in the neck or the armpit. This allows repeated testing and treatment of the child with cancer over a period of months while minimising the discomfort. The presence of CVC in the veins also leads to an increased risk of infections which can be life‐threatening. Our review systematically assessed the research done on strategies to prevent these infections in children with cancer. A total of three research studies were identified. Two studies showed that there may be a decrease in CVC‐related blood infections if the space in the CVC was washed and filled at regular intervals with urokinase (a drug which dissolves blood clots) with/without heparin (a drug which prevents the formation of blood clots) compared to heparin alone. One study showed that changing the dressing which covered the skin at the insertion of CVC every 15 days rather than every 4 days did not lead to an increased removal of the CVC because they had become infected. No research studies were identified for several other potential strategies which could reduce CVCrelated infections in children with cancer. TRADUZIONE ITALIANA Il trattamento dei bambini con cancro comporta spesso somministrazione di farmaci, liquidi e prodotti del sangue nelle vene. Inoltre, piccole quantità di sangue da parte del bambino sono spesso richiesti per le prove in laboratorio. Tutto questo può essere ottenuto mediante l'inserimento di un catetere venoso centrale (CVC), che è un piccolo tubo inserito attraverso la pelle nel vaso sanguigno nel collo o le ascelle. Questo permette ripetute procedure ed il trattamento del bambino con tumore per un periodo di mesi, riducendo al minimo i disagi. La presenza di CVC nelle vene comporta anche a un aumento del rischio di infezioni, che possono essere pericolose per la vita. La nostra revisione sistematica ha valutato la ricerca effettuata sulle strategie per prevenire queste infezioni nei bambini con cancro. Sono stati identificati in totale di tre studi clinici. Due studi hanno dimostrato che ci può essere una diminuzione delle infezioni del sangue CVC correlata, se il CVC è stato lavato e riempito a intervalli regolari con urochinasi (un farmaco che scioglie i coaguli di sangue) con / senza eparina (un farmaco che impedisce la formazione di coaguli di sangue) rispetto alla sola eparina. Uno studio ha dimostrato che cambiare la medicazione che copriva la pelle per l'inserimento di CVC ogni 15 giorni anziché ogni 4 giorni non ha portato a una necessità maggiore di rimozione del CVC, perché si era infettata. Non è stato identificato nessun altro studio che indichi altre diverse potenziali strategie che possono ridurre le infezioni correlate all’utilizzo del CVC nei bambini trattati per cancro. ABSTRACT
Background
Use of central venous catheters (CVC) in treatment of children with cancer is associated with infective complications. Current evidence based guidelines to prevent catheter‐related infections are mainly relevant to the adult population. They are not cancer (especially not childhood cancer) specific. Two existing Cochrane reviews have looked at prophylactic antibiotics and anticoagulants to prevent CVCrelated infections. Objectives
The primary objective was to find which interventions, if any, were effective in preventing CVC‐related infections in children with cancer. Further objectives were to examine the effectiveness of each intervention in the following subgroups: implanted versus external catheters, haematological versus non‐haematological malignancies, and in those receiving haematopoietic stem cell transplants (HSCT) versus no HSCT. Search strategy
We searched theCochrane Central Register of Controlled Trials (CENTRAL, TheCochrane Library 2008, Issue 4),MEDLINE (January 1950 to January 2009), EMBASE (January 1980 to January 2009) and CINAHL(R) (January 1982 toMarch 2009). We also searched reference lists of relevant articles and proceedings of relevant international conferences (2004 to 2008). Selection criteria
Randomised and quasi‐randomised studies comparing any intervention (other than anticoagulants, systemic antibiotics and antibiotic lock techniques) versus no intervention, placebo or any other intervention to prevent CVC‐related infections in children with cancer. Data collection and analysis
Two authors independently selected studies, assessed trial quality and extracted data. Where necessary, we contacted study authors for further data and clarification of methods. Main results
Three trials involving two different interventions were included. Two trials involving 680 children compared flushing CVC with urokinase (with or without heparin) versus heparin alone. Neither of these trials reported on the primary outcome of catheter‐related blood stream infection (CRBSI). There was a non‐significantly decreased rate of catheter‐associated infection (CAI) (Rate Ratio 0.72,95% confidence interval 0.12 to 4.41) in the urokinase (with or without heparin) arm compared with the heparin arm. One trial involving 113 children compared frequency of catheter dressing change every 15 days versus every 4 days. It did not report on CRBSI or CAI. There were no premature catheter removals for infection in either of the trial arms. Authors’ conclusions
Three RCTs for only two types of interventions to preventCVC‐related infections in children with cancer have been identified. Flushing CVC with urokinase (with or without heparin) compared to heparin alone possibly leads to decrease in CAI rates. Changing catheter dressings every 15 days versus every 4 days does not lead to more premature catheter removals due to infection although data were insufficient to assess if catheter‐related infection rates were changed. CIFAV‐Onlus Centro di Informazione sul Farmaco per l’Area Vasta Pordenonese. Via F. Gallini,2 33081 Aviano (PN) Italy www.cifav.it [email protected]