Antibiotic-coated Catheters Research Articles

The Neurosurgeon's Dilemma—Do Antiplatelet/Anticoagulant Medications Increase the Risk of Catheter-Associated Hemorrhage in External Ventricular Drain Placement?

IntroductionExternal ventricular drain (EVD) placement is a common neurosurgical procedure that can be performed at bedside. A frequent complication following EVD placement is catheter-associated hemorrhage (CAH). The hemorrhage itself is rarely clinically significant but may be complicated in patients taking anticoagulant or antiplatelet (AC/AP) medications. MethodsA total of 757 patients were who underwent EVD placement at bedside were included as part of a retrospective study at a large academic medical center. Demographic factors, use of AC/AP therapies, and several other clinical variables were recorded and assessed in univariate and multivariate regression analysis for association with CAH and mortality. ResultsOne hundred (13.2%) patients experienced CAH within 24 hours of the procedure. After univariate analysis, in two tandem-run multivariate regression analyses after stepwise variable selection, use of two or more AC/AP agents (OR=2.362, p=0.020) and dual antiplatelet therapy with aspirin and clopidogrel (OR=3.72, p=0.009) were significantly associated with CAH. Use of non-coated catheters was a protective factor against CAH compared to use of antibiotic-coated catheters (OR=0.55, p=0.019). Multivariate analysis showed age, multi-agent therapy, and thrombocytopenia were significantly associated with increased mortality. ConclusionThere was increased risk of CAH after EVD placement in patients taking more than one AC/AP agent regardless of presenting pathology. In particular, use of aspirin and clopidogrel combined was associated with significantly higher odds of CAH, although it was not associated with higher mortality. In addition, there appears to be an association between use of antibiotic-coated catheters and CAH across univariate and multivariate analysis.

A sustainable approach to control biofilms infections and reduce medical waste: Catheters coated with antibiotics inhibit single and dual-species biofilms

Catheter-Associated Urinary Tract Infections (CAUTIs) are one of the major diseases that cause severe illness and death among the wider population. More than 30,000 deaths are reported each year due to CAUTI. These infections are caused due to different biofilm- forming species such as Escherichia coli (E. coli), Enterococcus faecalis (E. faecalis), Candida spp, Klebsiella spp, Proteus spp, Bacteroides spp, Staphylococcus aureus, and Enterobacter spp. This study examined the growth of two major uropathogenic (E. coli and E. faecalis) strains on catheter surfaces under antibiotic-treated and untreated conditions. The antibiotics used for this study are Ciprofloxacin and Doxycycline, which are considered to be broad-spectrum antibiotics. The Minimum Inhibitory Concentration (MIC) assay was performed to identify the concentration at which these antibiotics show efficient inhibition. The results show that both antibiotics have an inhibitory effect on single and dual-species biofilms. However, E. coli is more resistant to Doxycycline (MIC: 100 μg/mL), whereas E. faecalis is more resistant to Ciprofloxacin (MIC: 50 μg/mL). Interestingly, the dual-species cultures are more susceptible to both antibiotics at lower concentrations, 5μg/mL. Furthermore, a CFU assay was performed to quantify the results obtained, and a similar trend could be observed with around a 4-fold reduction in bacterial colonies when catheters are coated with antibiotics. In addition, the antibiotic-coated catheters contribute no pathogen contamination to the environment.

Transcriptomic Response of Human Nosocomial Pathogen Pseudomonas aeruginosa Biofilms Following Continuous Exposure to Antibiotic-Impregnated Catheters

Biofilms are complex surface-attached bacterial communities that serve as a protective survival strategy to adapt to an environment. Bacterial contamination and biofilm formation on implantable medical devices pose a serious threat to human health, and these biofilms have become the most important source of nosocomial infections. Although antimicrobial-impregnated catheters have been employed to prevent bacterial infection, there have been concerns about the potential emergence of antibiotic resistance. To investigate the risk of developing resistance, we performed RNA-sequencing gene expression profiling of P. aeruginosa biofilms in response to chronic exposure to clindamycin and rifampicin eluted from antibiotic-coated catheters in a CDC biofilm bioreactor. There were 877 and 178 differentially expressed genes identified in planktonic and biofilm cells after growth for 144 h with control (without antibiotic-impregnation) and clindamycin/rifampicin-impregnated catheters, respectively. The differentially expressed genes were further analyzed by Clusters of Orthologous Groups (COGs) functional classification and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. The data are publicly available through the GEO database with accession number GSE153546.

Broad spectrum antimicrobial PDMS-based biomaterial for catheter fabrication

BackgroundIn addition to the widespread use of antibiotics in healthcare settings, the current COVID-19 pandemic has escalated the emergence of antibiotic resistance. Nosocomial infections among hospitalized patients is a leading site for such resistant microbial colonization due to prolonged use of invasive devices and antibiotics in therapies. Invasive medical devices, especially catheters, are prone to infections that could accelerate the development of resistant microbes. Often, catheters - particularly urinary catheters - are prone to high infection rates. Antibiotic-coated catheters can reduce infection rates and although commercially available, are limited in efficacy and choices.MethodsHerein, a novel and facile method to fabricate PMDS-based biomaterial for the development of antimicrobial eluting catheters is presented. Silicone based organic polymer polydimethylsiloxane (PDMS) was used to prepare a biomaterial containing novel polymeric imidazolium antimicrobial compound.ResultsIt was found that the PDMS-based biomaterials could eradicate microbial colonization even after 60 days in culture with continuous microbial challenge, be recycled over multiple uses, stored at room temperature for long-term usage and importantly is biocompatible.ConclusionThe PDMS-based biomaterial displayed biocidal functionality on microbes of clinical origin, which form major threats in hospital acquired infections.Graphical

Clinical review: Efficacy of antimicrobial-impregnated catheters in external ventricular drainage - a systematic review and meta-analysis

To assess the efficacy of antimicrobial-impregnated catheters in preventing catheter-related infections during external ventricular drainage (EVD), we performed a meta-analysis and systematic review. We systematically searched Medline, Embase, and the Cochrane Library. All randomized controlled trials (RCTs) and nonrandomized prospective studies (NPSs) related to antimicrobial-impregnated EVD catheters were included. The primary outcome was the rate of cerebrospinal fluid infection (CFI). The secondary outcomes included the rate of time-dependent CFI and catheter bacterial colonization. We further performed subgroup analysis, meta-regression analysis, and microbial spectrum analysis. Four RCTs and four NPSs were included. The overall rate of CFIs was 3.6% in the antimicrobial-impregnated catheter group and 13.7% in the standard catheter group. The pooled data demonstrated that antimicrobial-impregnated catheters were superior to standard catheters in lowering the rate of CFIs (odds ratio (OR) = 0.25, 95% confidence interval (CI) = 0.12 to 0.52, P <0.05). In survival analysis, the 20-day infection rate was significantly reduced with the use of antimicrobial-impregnated catheters (hazard ratio = 0.52, 95% CI = 0.29 to 0.95, P <0.05). Furthermore, a significantly decreased rate of catheter bacterial colonization was noticed for antimicrobial-impregnated catheters (OR = 0.37, 95% CI = 0.21 to 0.64, P <0.05). In subgroup analyses, although significant results remained for RCTs and NPSs, a subgroup difference was revealed (P <0.05). Compared with standard catheters, a significantly lower rate of CFIs was noticed for clindamycin/rifampin-impregnated catheters (OR = 0.27, 95% CI = 0.10 to 0.73, P <0.05) and for minocycline/rifampin-impregnated catheters (OR = 0.11, 95% CI = 0.06 to 0.21, P <0.05). However, no statistical significance was found when compared with silver-impregnated catheters (OR = 0.33, 95% CI = 0.07 to 1.69, P = 0.18). In microbial spectrum analysis, antimicrobial-impregnated catheters were shown to have a lower rate of Gram-positive bacterial infection, particularly the coagulase-negative Staphylococcus. In conclusion, the use of antimicrobial-impregnated EVD catheters could be beneficial for the prevention of CFI and catheter bacterial colonization. Although antibiotic-coated catheters seem to be effective, no sufficient evidence supports the efficacy of silver-impregnated catheters.

Strategies to Decrease the Risk of Ventricular Catheter Infections: A Review of the Evidence

The use of antibiotic-coated external ventricular catheters has been controversial among practitioners; although several papers have documented decreased adherence of microbes to catheters treated with antibiotics, there is no universally accepted practice standard for the use of coated catheters for the prevention of clinical infection. In this paper, we review the in vivo and in vitro evidence for antibiotic-coated catheters.

Prevention of central line associated bloodstream infections in critical care units

Central line associated bloodstream infections (CLABSIs) are a common source of morbidity and mortality in neonatal and pediatric intensive care units. Successful preventive strategies have recently been reported which have resulted in significant reductions in CLABSIs and their associated adverse outcomes. Current surveillance data indicate a recent decline in reported CLABSI rates, likely secondary to changes in diagnostic criteria and improvements in central line care. Recent pilot randomized trials in the neonatal intensive care unit population have assessed the safety and efficacy of chlorhexidine gluconate for cutaneous antisepsis and silver alginate-impregnated dressings. No significant reductions in CLABSIs have been noted with the use of either. The greatest success has come with implementation of evidence-based catheter care bundles, which have been shown in individual units and collaborative critical care networks to significantly reduce CLABSI rates. CLABSIs remain a significant problem in neonatal and pediatric critical care units, but implementation of catheter care bundles can significantly reduce rates of these infections. The safety and efficacy of chlorhexidine gluconate, silver alginate, and antibiotic-coated catheters need to be assessed via large, multicenter trials. Creation of collaborative networks may facilitate this goal.

Current strategies for the prevention and management of central line-associated bloodstream infections

Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs). While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment.

Innovative parenteral and enteral nutrition therapy for intestinal failure

Children with intestinal failure (IF) suffer from insufficient intestinal length or function, making them dependent on parenteral nutrition (PN) for growth and survival. PN and its components are associated with many complications ranging from simple electrolyte abnormalities to life-threatening PN-associated liver disease, which is also called intestinal failure-associated liver disease (IFALD). From a nutrition perspective, the ultimate goal is to provide adequate caloric requirements and make the transition from PN to full enteral nutrition (EN) successful. Upon review of the literature, we have summarized the most effective and innovative PN and EN therapies for this patient population. Antibiotic-coated catheters and antibiotic or ethanol locks can be implemented, as they appear effective in reducing catheter-related infection and thus further reduce the risk of IFALD. Lipid emulsions should be given judiciously. The use of an omega-3 fatty acid-based formulation should be considered in patients who develop IFALD. Trophic feeding is important for intestinal adaptation, and EN should be initiated early to help wean patients from PN. Long-term management of children with IF continues to be an emerging field. We have entered uncharted territory as more children survive complications of IF and IFALD. Careful monitoring and individualized management to ensure maintenance of growth while avoiding complications are the keys to successful patient outcomes.

Catecholamine Inotrope Resuscitation of Antibiotic‐Damaged Staphylococci and Its Blockade by Specific Receptor Antagonists

The increasing use of antibiotic-coated catheters, such as those containing rifampin or minocycline, has led to a decrease in catheter colonization by staphylococci but not to a decrease in the incidence of catheter-related bloodstream infection (BSI). Because catheters are used for the administration of catecholamine inotropes to maintain cardiac function, we examined whether 2 commonly employed inotropes, dopamine and norepinephrine, could affect bacterial viability after exposure to rifampin and minocycline. Rifampin inhibition and minocycline inhibition of staphylococcal growth could be reversed by exposure to dopamine or norepinephrine as a result, in part, of catecholamine-mediated increased provision of host-sequestered iron. The simultaneous addition of inotropes with an antibiotic did not affect antibiotic susceptibility. Inotrope-induced growth in bacteria previously exposed to antibiotics was blocked by the inclusion in culture media of specific catecholamine-receptor antagonists. Considered collectively, these results provide a mechanistic basis for understanding how host-related factors, such as inotrope-based therapeutics, may influence the recovery of antibiotic-stressed bacteria in clinical settings.

Prevention of primary bacteraemia

This overview provides information on recent advances in the prevention of primary bacteraemia, commonly defined as bloodstream infection without a documented source of infection, but including those resulting from an intravenous or arterial line infection. The potential to prevent community-acquired, primary bacteraemia is still limited and may be targeted mainly at vaccines for high-risk groups. In contrast, the prevention of catheter-related bacteraemia has seen substantial progress within the last 10 years. Consequently, intravascular device-related bacteraemia has become largely preventable under routine working conditions. Independent of the use of antibiotic-coated catheters, the implementation of clinical pathways and multimodal preventive strategies directed at several risk factors of catheter-related bacteraemia is a successful strategy to reduce this potentially life-threatening infection and deserves future health services research.

Can Antibiotic-Coated Catheters Help Decrease the Incidence of Bloodstream Infections in Patients in the Intensive Care Unit?

Can Antibiotic-Coated Catheters Help Decrease the Incidence of Bloodstream Infections in Patients in the Intensive Care Unit?

Changes in the etiology of bacteremia in febrile neutropenic patients and the susceptibilities of the currently isolated pathogens.

The etiology of bacteremia in febrile neutropenic patients in the past few decades has shifted from gram-negative to gram-positive organisms. Potential reasons include the use of indwelling catheters, local environmental conditions, and the administration of specific antibiotic agents, especially as prophylaxis. Other factors may emerge from new studies, such as the categorization of febrile neutropenic patients into groups at low risk and at high risk of developing serious complications, continuing changes in resistance in the community, the use of antibiotic-coated catheters, and future changes in cytotoxic chemotherapy or antineoplastic therapy. In addition, there has been a drift in susceptibility patterns, with resistance issues seen in the general population of hospitalized patients now emerging in febrile neutropenic patients, as well as some issues specific to these patients. These changes affect empirical therapy as it was practiced a decade ago. Among the most commonly used agents, cefepime and carbapenems continue to show the highest rates of in vitro susceptibility, providing coverage against most gram-positive and gram-negative organisms and reducing the need for glycopeptides. Older agents continue to show degradation of their effectiveness. Among Pseudomonas aeruginosa strains, susceptibility to all agents continues to decline.

Infections urinaires nosocomiales : définition, diagnostic, physiopathologie, prévention, traitement

A 10 5cfu mL –1 bacteriuria is usual for the threshold NUTI diagnosis; but it is discussed by authors. Leucocyturia is less used. There is no any study with validated methodology demonstrating how to prevent NUTI. Some criteria are commonly accepted: rigorous asepsis during catheterization of the urinary tract, closed drainage. The role of the antibiotic-coated catheters, of the systematic antibioprophylaxis and of the instillation of antibacterial agents in the urinary catheter is not demonstrated yet. There are less data concerning the curative treatment of NUTI. The most frequently used antibiotics are: fluoroquinolones, trimethoprim-sulfametoxazole, and cefalosporins. The optimal duration of treatment ranges from 5 to 15 days. The urinary catheter change is a controversial matter. The main study relating the incidence of nosocomial infections (SENK project) shows that 5.7% of hospitalized patients experiment a nosocomial infection during their stay. Epidemiological data of nosocomial infections are mainly relative to intensive care units. NUTI figure the main part of these infections, accounting for 40% of the whole nosocomial infections (80% occur in patients with urinary catheterization). In these patients, the daily incidence of urinary tract infection ranges from 5 to 10%. They are usually benign. The occurrence of bacteriemia ranges from 1 to 4%. Induced mortality is 0.8%. It induces longer stay and cost overrun. However, NUTI are important because of their frequency, and not because of their severity.

Antibiotic-Coated Catheters Do Not Promote Resistance, 4-Year Study Shows

Antibiotic-Coated Catheters Do Not Promote Resistance, 4-Year Study Shows

Controversies in the Antibiotic Management of Critically Ill Patients

Preventing infection, managing antibiotics, and controlling antibiotic resistance are integral to the daily practice of any physician caring for critically ill patients. Many controversies remain in this area, but improving our ability to manage anti-infective drugs is likely to be a determinant factor on the outcome of critically ill patients. Several measures to prevent nosocomial infections are available, including selective digestive decontamination (SDD) and antibiotic-coated catheters, but a careful assessment of the effect of these strategies upon resistance is needed before considering their extensive use in the ICU. Antibiotic therapy of severely infected patients can be considered as a two-step contract, the first part of which consists in providing individual patients with the best antibiotic strategy. This raises important, although often unsolved, questions regarding the dose, the interest of combining two antibiotics, and the length of therapy. The second part of the contract concerns not only individual patients but the community. Reassessment of the initial therapy is mandatory to avoid prolonged and unnecessary usage of broad spectrum and costly antibiotics, which increase resistance pressure. In many cases, antibiotics can be either stopped or changed after 2 or 3 days.

Haemodialysis catheter bacteraemia: evolving strategies.

This article reviews the new trends in the diagnosis, treatment and prevention of catheter-related bacteraemia in clinical nephrology. Among these are the newer diagnostic techniques of evaluating and obtaining culture specimens from central lines, such as timed cultures and use of the endoluminal brush. In general, attempts to salvage infected haemodialysis lines are unsuccessful. We review the data that pertain to the use of antibiotic-coated catheters in non-dialysis patients and discuss how these observations may be applied to end-stage renal disease patients.

Efficacy of antibiotic-coated catheters in preventing subcutaneous Staphylococcus aureus infection in rabbits.

Vascular catheters coated with antiinfective compounds were evaluated as to their ability to prevent Staphylococcus aureus catheter infection in a rabbit model. Zones of inhibition of agar surface-plated S. aureus demonstrated the following hierarchy: dicloxacillin and clindamycin were each better than fusidic acid or chlorhexidine, which were better than ciprofloxacin, cefotaxime, or cefuroxime. In vivo half-lives of inhibitory activity for clindamycin and dicloxacillin were 5.6 and 17.7 h, respectively, with apparent first-order kinetics. Chlorhexidine disappeared in vivo with apparent two-compartment kinetics: first-compartment t1/2, 16.8 h; second-compartment t1/2, 115.6 h. In a rabbit model, dicloxacillin, clindamycin, fusidic acid, and chlorhexidine decreased the risk of infection compared with uncoated control catheters (P < .05). For dicloxacillin, clindamycin, and chlorhexidine, this was true even if the S. aureus inoculation was delayed 48 or 96 h after catheter implantation. These data suggest that vascular catheters with antiinfective coatings should be investigated further in hospitalized patients.