Abstract
BackgroundAntimicrobial catheters have been utilized to reduce risk of catheter colonization and infection. We aimed to determine if there is a greater than expected risk of microorganism-specific colonization associated with the use of antimicrobial central venous catheters (CVCs).MethodsWe performed a meta-analysis of 21 randomized, controlled trials comparing the incidence of specific bacterial and fungal species colonizing antimicrobial CVCs and standard CVCs in hospitalized patients.ResultsThe proportion of all colonized minocycline-rifampin CVCs found to harbor Candida species was greater than the proportion of all colonized standard CVCs found to have Candida. In comparison, the proportion of colonized chlorhexidine-silver sulfadiazine CVCs specifically colonized with Acinetobacter species or diphtheroids was less than the proportion of similarly colonized standard CVCs. No such differences were found with CVCs colonized with staphylococci.ConclusionCommercially-available antimicrobial CVCs in clinical use may become colonized with distinct microbial flora probably related to their antimicrobial spectrum of activity. Some of these antimicrobial CVCs may therefore have limited additional benefit or more obvious advantages compared to standard CVCs for specific microbial pathogens. The choice of an antimicrobial CVC may be influenced by a number of clinical factors, including a previous history of colonization or infection with Acinetobacter, diphtheroids, or Candida species.
Highlights
Central venous catheters (CVCs) have become essential in the management of critically ill patients, as well as other patient populations requiring acute or long-term medical care
We studied central venous catheters (CVCs) colonization rather than CVC-related bloodstream infection since endemic CVC infections start with microbial colonization prior to the development of CVC-related bloodstream infection
We performed a search in Cochrane, MEDLINE, and EMBASE databases of randomized controlled trials from 1995 to current with the following strings: “central venous catheter”, “colonization”, “catheter colonization”, “bloodstream infection”, “bacteremia”, “chlorhexidine”, “benzalkonium chloride”, “rifampicin”, “minocycline”, “silver”, and “miconazole”
Summary
Central venous catheters (CVCs) have become essential in the management of critically ill patients, as well as other patient populations requiring acute or long-term medical care. Intravascular catheters can become colonized by microbial pathogens following an extraluminal or intraluminal route of endemic infection emanating from the insertion site and catheter connector/hub, respectively [1]. Most studies have shown a 2 to 10-fold increase in episodes of CVC colonization compared to CVC-related bloodstream infection [2]. The greatest likelihood of uncovering any potential gaps in the spectrum of activity of antimicrobial CVCs would best be done by assessing CVC colonization. Antimicrobial catheters have been utilized to reduce risk of catheter colonization and infection. We aimed to determine if there is a greater than expected risk of microorganism-specific colonization associated with the use of antimicrobial central venous catheters (CVCs)
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