The GDG noted that the use of antibiotic-impregnated CVCs should be reserved for specific indications, for example, in high-risk patients (such as immunosuppressed individuals).

• However, some GDG members raised strong concerns about the use of antibiotic-impregnated CVCs and the theoretical and potential development of antimicrobial resistance (including in Mycobacterium tuberculosis when using rifampicin as coating agent).
• The GDG also specifically requested the performance of a systematic review on the costeffectiveness of using antibiotic-impregnated CVCs. Upon evaluation of the results, the GDG acknowledged that all the cost-effectiveness studies were performed in HICs and the affordability and clinical impact of these catheters in LMICs have yet to be assessed.
• Many studies evaluating antibiotic-impregnated central venous catheters (CVCs) were conducted prior to the widespread implementation of infection prevention bundles, making it unclear whether these catheters have a measurable impact on CLABSI rates in current practice. It was also noted that the majority of these studies date back several years.
• Moreover, most studies were performed in settings with high baseline CLABSI rates, and their findings may not be generalisable to clinical environments where catheter-related infections are already infrequent.
• The recommendation applies to adults, adolescents and children, but not neonates, because only antibiotic-impregnated PICC lines are available for this age group.
• Health care facilities with high CLABSI rates should first consider the implementation and compliance with the other recommendations present in these guidelines before considering the adoption of antibiotic-impregnated catheters.
• Patients should be monitored for allergic reactions, including anaphylaxis.