Incidence, morbidité et mortalité des infections dues aux cathéters veineux centraux en réanimation

Analyse critique de la littérature sur l’utilisation comparée de deux antiseptiques lors du cathétérisme vasculaire ou rachidien

OBJECTIVES

To analyze the most pertinent data from the literature concerning the use of an antiseptic solution before the elaboration of invasive procedures such as blood cultures, insertion of peripheral or central intravenous catheters, and arterial or epidural catheters, and to identify, if any, the "ideal" antiseptic or, at least, the most efficient.

DATA SOURCES

Review of the literature. Data collected from the Medline database concerning experimental, clinical and basic research studies published between 1966 and 2003 and a manual research of references of relevant papers.

RESULTS

After a brief historic and pharmacological reminder, the results of experimental and clinical studies are presented. Concerning the clinical studies, they concerned almost exclusively iodine products and chlorhexidine. These comparative studies are classified according to the punction site and the antiseptic solution used.

CONCLUSION

Even if the in vitro studies favor iodine products, chlorhexidine in alcoholic solution seems more efficient than povidone iodine in aqueous solution in the clinical setting. Several explanations are suggested to understand the in vitro/in vivo discordances. The place of povidone iodine in alcoholic solution, whose performances on the healthy skin are similar to those of alcoholic chlorhexidine, is being in evaluation.