Effectiveness of Antiseptic and Antibiotic Use to Prevent Central Line-Associated Bloodstream Infections in ICU Patients: A Systematic Review and Narrative Synthesis of Randomized Clinical Trials

OBJECTIVE: The aim of this study was to conduct a narrative synthesis of randomized trials to evaluate the evidence on the effectiveness of antibiotics and antiseptics in preventing central line-associated bloodstream infection (CLABSI) in intensive care unit patients. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, CINAHL, and Scopus databases were searched for randomized controlled trials published from 2012 to March 2024. The methodological quality of the included studies was independently evaluated by 2 reviewers using the Critical Appraisal Skills Programme Spanish [Español] appraisal tool. Following data extraction, a narrative synthesis was performed to integrate and interpret the findings across studies. The protocol was registered in advance in the Prospective Register of Systematic Reviews (PROSPERO). RESULTS: Nineteen randomized trials were appraised using the Critical Appraisal Skills Programme Spanish [Español] tool, of which 13 high-quality studies (score ≥6) were included in the review. These trials assessed antiseptic (alcohol, chlorhexidine), antibiotic (rifampin), or combined interventions versus standard care. Antiseptic and antibiotic-impregnated catheters and alcohol caps were associated with reduced CLABSI rates, hospital stay, and costs, while evidence for alcohol lock therapy was inconclusive. CONCLUSION: This review supports the use of antiseptic and antibiotic-coated catheters as promising measures to prevent CLABSI in critically ill patients. However, caution is warranted with alcohol lock therapy due to limited and conflicting evidence.