Antibiotic Use at Planned Central Line Removal in Reducing Neonatal Post-Catheter Removal Sepsis: A Systematic Review and Meta-analysis

Background: Post-catheter removal sepsis (PCRS) is a severe complication of indwelling central venous catheters (CVCs) in neonates, which is postulated to be secondary to the disruption of biofilms formed along catheter tips upon CVCs removal. It remains controversial whether antibiotic use upon CVCs removal will help to prevent this situation. We aimed to evaluate the protective effect of antibiotic administration at the time of CVCs removal in preventing PCRS in neonates. Methods: The systematic review was performed based on a registered protocol (CRD42022359677). We searched through PubMed, EMBASE and Cochrane databases, as well as reference lists of review articles (September 2022) for studies comparing the use of antibiotics versus no use within 12 hours of CVCs removal. Selection of studies and data extraction were performed independently by two researchers. Risk of bias was assessed using the modified Newcastle-Ottawa Scale or Cochrane risk-of-bias tool according to the study design. Results of quantitative analyses were presented as mean differences (MD) or odds ratio (OR). Subgroup and univariate meta-regression analyses were performed to identify heterogeneity. Results: : The review included 470 central lines in the antibiotic group and 658 lines in the control group from five studies. Antibiotic use within 12 hours of CVCs removal did not significantly reduce the incidence of PCRS (OR=0.35, 95% CI: 0.08 to 1.53), but was associated with a lower incidence of post-catheter removal blood stream infection (OR=0.31, 95% CI: 0.11 to 0.86). Dosage of vancomycin and world region were major sources of interstudy heterogeneity. Conclusion: Antibiotic administration in neonates upon CVCs removal does not significantly reduce the incidence of PCRS but offers less post-catheter removal blood stream infection. Whether this will be converted to better clinical outcomes lacks evidential support. Further randomized controlled studies with longer follow-up are needed.