During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique. A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed. Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53–0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49–0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41–0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48–0.87). US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.

中文翻译：

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中心静脉导管相关感染： 比较超声引导和标志性插入技术的系统评价、荟萃分析、试验序贯分析和荟萃回归


在中心静脉导管插入术 （CVC） 期间，与解剖标志 （AL） 技术相比，超声 （US） 引导可减少机械并发症并提高成功率。然而，美国指南对导管相关感染的影响仍然存在争议。本系统评价和荟萃分析旨在比较美国引导的 CVC 与 AL 技术的导管相关感染风险。对 MEDLINE、Cochrane 对照试验中心注册库 （CENTRAL） 和 Web of Science 数据库进行了系统检索，检索日期截至 2024 年 7 月 31 日。纳入比较美国指导与 AL 引导的 CVC 放置的随机对照试验 （RCT） 和非随机干预研究 （NRSI）。主要结局是复合结局，包括所有类型的导管相关感染： 导管相关血流感染 （CRBSI） 、中心插管相关血流感染 （CLABSI）、导管定植或任何其他类型报告的感染。次要结局包括个体感染类型和第 28 天的死亡率。还进行了基于研究类型和操作者经验的亚组分析。合并 12 项研究 （8 项 RCT 和 4 项 NRSI），共 5,092 例 CVC 手术 （2072 例 US 引导和 3020 例 AL 引导），与 AL 技术相比，US 引导的 CVC 与导管相关感染的显著减少相关（风险比 （RR） = 0.68,95% 置信区间 （CI） 0.53-0.88）。在 RCT 亚组中，合并 RR 为 0.65 （95% CI 0.49–0.87）。这种影响在有经验的操作者进行的手术中更为明显 （RR = 0.60,95% CI 0.41–0.89）。在缺乏经验的操作者中，感染风险降低没有统计学意义。 CRBSI 和 CLABSI 的汇总分析也支持美国指导 （RR = 0.65,95% CI 0.48–0.87）。与 AL 技术相比，美国引导的 CVC 置入显着降低了导管相关感染的风险，尤其是由经验丰富的操作员进行时。试验注册 PROSPERO CRD42022350884.2022 年 8 月 13 日注册。