The Centers for Disease Control (CDC) provides recommendations for the prevention of catheter-related infections when using central venous catheters. The CDC does not recommend the use of antimicrobial prophylaxis (O’Grady 2002
). However, in some neonatal units it is standard practice to use antimicrobial prophylaxis in infants with central venous catheters in an attempt to reduce catheter colonisation and thereby reduce the risk of acquired infection. The choice of antibiotics depends on the most frequently encountered organisms, which may vary with local circumstances. Based on their own experience and retrospective analysis, Shaul et al (Shaul 1998
) recommend antibiotic prophylaxis at the time of insertion of tunneled or implantable subcutaneous central venous catheters. In a randomised controlled trial, Henrickson et al (Henrickson 2000
) demonstrated a reduction in infection following administration of antibiotic/heparin solutions to paediatric oncology patients with tunneled central venous catheters. They concluded that the prophylaxis was well tolerated and stated that it would not lead to an increase in emergence or spread of vancomycin-resistant enterococcus since they did not find any in their study.
Prophylactic antibiotics may be effective in preventing catheter-related blood stream infection in newborns, but may have the undesirable effect of promoting the emergence of resistant strains of micro-organisms (Freij 1999) or of altering the pattern of isolates causing infection (Viudes 2002). A policy of prophylactic antibiotic use must take this possibility into account, and this possibility has been used as a basis for arguing against implementation of prophylactic antibiotics (Haas 2003; Isaacs 2000; Isaacs 2003; McGuire 2004). The emergence of resistant strains of organisms will develop over time and this resistance may vary depending upon the antibiotic.
Recent Cochrane systematic reviews on the use of prophylactic antibiotics for neonates with umbilical artery (Inglis 2004) and umbilical venous (Inglis 2005) catheters showed that there was no evidence from randomised trials to support or refute the use of prophylactic antibiotics when using such catheters in newborn infants. The following systematic review evaluates the use of prophylactic antibiotics for neonates with central venous catheters.