Prophylactic antibiotics for preventing gram‐positive infections associated with long‐term central venous catheters in adults and children receiving treatment for cancer

Background This is an updated version of a Cochrane Review last published in 2013. Long‐term central venous catheters (CVCs), including tunnelled CVCs (TCVCs) and totally implanted devices or ports (TIDs), are increasingly used when treating people with cancer. Despite international guidelines on sterile insertion and appropriate CVC maintenance and use, infections remain a common complication. These infections are mainly caused by gram‐positive bacteria. Antimicrobial prevention strategies aimed at these micro‐organisms could potentially decrease the majority of CVC‐related infections. The aim of this review was to evaluate the efficacy of prophylactic antibiotics for the prevention of gram‐positive infections in people with cancer who have long‐term CVCs. Objectives To assess the effects of administering antibiotics prior to the insertion of long‐term CVCs or as a flush/lock solution, or both during long‐term CVC access to prevent gram‐positive CVC‐related infections in adults and children receiving treatment for cancer. Search methods The search for this updated review was conducted on 19 November 2020. We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE via Ovid and Embase via Ovid. We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform portal for additional articles. Selection criteria We included randomised controlled trials (RCTs) that compared either the administration of prophylactic antibiotics prior to long‐term CVC insertion versus no administration of antibiotics, or the use of an antibiotic versus a non‐antibiotic flush/lock solution in long‐term CVCs, in adults and children receiving treatment for cancer. Data collection and analysis We used standard methodological procedures expected by Cochrane. Two authors independently selected studies, classified them and extracted data onto a predesigned data collection form. The outcomes of interest were gram‐positive catheter‐related infection events and total number of CVCs and CVC days. We pooled the data using a random‐effects model for meta‐analyses. We used the GRADE approach to assess the certainty of the evidence. Main results For this update, we identified 310 potentially relevant studies and screened them for eligibility. We included one additional RCT with 404 participants. The original review included 11 RCTs with a total of 840 people with cancer (adults and children). In total