Influence of triple-lumen central venous catheters coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia
Authors
Heard, Stephen O.Wagle, Manisha
Vijayakumar, Elamana
McLean, Susan
Brueggemann, Angela
Napolitano, Lena M.
Edwards, L. Paul
O'Connell, Frank M.
Puyana, Juan Carlos
Doern, Gary V.
Document Type
Journal ArticlePublication Date
1998-01-12Keywords
Anti-Infective Agents, LocalBacteremia
Catheterization, Central Venous
Chlorhexidine
Female
Humans
Incidence
Male
Middle Aged
Prospective Studies
Risk Factors
Silver Sulfadiazine
Treatment Outcome
Anesthesiology
Bacteria
Equipment and Supplies
Surgery
Metadata
Show full item recordAbstract
OBJECTIVE: To evaluate the efficacy of triple-lumen central venous catheters coated with a combination product of chlorhexidine and silver sulfadiazine (CSS) in reducing the incidence of local catheter infection and catheter-related bacteremia. DESIGN: Randomized, controlled trial. SETTING: The surgical intensive care units in a university hospital. PATIENTS: All patients who needed central venous catheterization were randomized to receive either an uncoated triple-lumen catheter (n = 157) or a catheter coated with CSS (n = 151). MAIN OUTCOME MEASURE: Catheters were removed when no longer needed or suspected as a cause of infection. The tip and a 5-cm segment of the intradermal portion of the catheter were cultured semiquantitatively. Blood cultures were obtained when clinically indicated. The remaining segment of catheters coated with CSS were cut and incubated on an agar plate with strains of Staphylococcus aureus and Enterococcus. Zone of inhibition was determined 24 hours later. Data were analyzed by survival and logistic multivariate regression methods. RESULTS: Catheters coated with CSS were effective in reducing the rate of significant bacterial growth on either the tip or intradermal segment (40%) compared with control catheters (52%; P = .04). However, there was no difference in the incidence of catheter-related bacteremia (3.8% [uncoated] vs 3.3% [coated]; P = .81). In vitro activity of catheters with CSS against S aureus was evident up to 25 days but activity against Enterococcus dissipated more quickly over time and was absent by day 4. The most common colonizing organisms were coagulase-negative staphylococcus and enterococcus. Variables that were associated with a significant amount of growth on the tip or intradermal segment were a duration of catheterization of longer than 7 days, jugular insertion site, and the absence of a CSS coating. The use of a guidewire when the catheter was removed was associated with a lower risk of significant bacterial growth. CONCLUSIONS: The use of CSS reduces the incidence of significant bacterial growth on either the tip or intradermal segments of coated triple-lumen catheters but has no effect on the incidence of catheter-related bacteremia. In this patient population, catheters coated with CSS provide no additional benefit over uncoated catheters.Source
Arch Intern Med. 1998 Jan 12;158(1):81-7.
DOI
10.1001/archinte.158.1.81Permanent Link to this Item
http://hdl.handle.net/20.500.14038/25796PubMed ID
9437382Related Resources
ae974a485f413a2113503eed53cd6c53
10.1001/archinte.158.1.81