Chlorhexidine-silver Sulfadiazine Research Articles

The potential for developing new antimicrobial resistance from the use of medical devices containing chlorhexidine, minocycline, rifampicin and their combinations: a systematic review.

BackgroundCatheter infections remain one of the most persistent adverse events causing significant morbidity, economic impact and mortality. Several strategies have been proposed to reduce these infections including the use of catheters embedded with antibiotics and/or antiseptics. One reoccurring challenge is the fear that antimicrobial medical devices will induce resistance. The aim of this systematic review is to evaluate the evidence for induced antimicrobial resistance caused by exposure to antimicrobial medical devices.MethodsFour electronic databases [MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Scopus] were screened for studies published between 1983 and 2019 regarding assessment of microbial resistance with use of medical devices containing chlorhexidine, minocycline, rifampicin or combinations thereof. Development of new resistance, selection for tolerant organisms and ‘no change in resistance’ were assessed.ResultsForty-four publications, grouped by study type and stratified by drug assessed, were included for analyses. The majority of studies found no change in resistance after exposure to antimicrobial medical devices (13 in vitro, 2 in vivo, 20 clinical). Development of new resistance was commonly reported with the use of rifampicin as a single agent and only reported in one study assessing the minocycline/rifampicin combination (M/R); however, the increase in MIC was well below clinical relevance.ConclusionsEmergence of new resistance to combinations of M/R, minocycline/rifampicin/chlorhexidine (M/R/CH) and chlorhexidine/silver sulfadiazine (CHXSS) was rare. No clinical trials confirmed its occurrence and some refuted it. The risk of development of new resistance to these antimicrobial combinations appears more fear-based than substantiated by clinical and experimental evidence but warrants continued surveillance.

Anti-Candida activity of antimicrobial impregnated central venous catheters

BackgroundWhenever the rate of central line-associated bloodstream infections (CLABSIs) remains high even after the implementation of preventive strategies, the use of chlorhexidine/silver sulfadiazine (CSS) or minocycline/rifampin (MR)-impregnated central venous catheters (CVCs) is currently recommended. Nevertheless, the efficacy of such CVCs against Candida albicans and other emerging non-albicans spp. has been insufficiently studied. This study aims to compare the activity of CSS and MR-impregnated CVCs against the yeasts most frequently isolated from CLABSIs.MethodsFor biofilm formation assays, type strains and clinical isolates of C. albicans, C. glabrata and C. parapsilosis sensu stricto were used. Segments of standard polyurethane, MR and second-generation CSS-CVCs were tested. The biofilm metabolic activity was measured by a semi-quantitative XTT reduction assay.ResultsCSS catheter segments significantly reduced the biofilm metabolic activity by all tested Candida spp., with inhibition ranging from 60% to 100%. The MR catheter segments promoted C. albicans and C. parapsilosis biofilm formation and exhibited an inconspicuous effect against C. glabrata.ConclusionsAmong the recommended antimicrobial CVCs, CSS-CVCs proved to be superior in the inhibition of biofilm formation by the most frequent yeasts causing CLABSIs. Data from this in vitro study may suggest that patients at high risk for invasive candidosis could benefit from the use of CSS-CVCs.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy

Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study. This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy. Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day ($3.78 ± $7.43 vs $3.31 ± $2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001). The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.

Antimicrobial-impregnated catheters for the prevention of catheter-related bloodstream infections.

Central venous catheters are commonly used in critically ill patients. Such catheterization may entail mechanical and infectious complications. The interest in catheter-related infection lies in the morbidity, mortality and costs that it involved. Numerous contributions have been made in the prevention of catheter-related infection and the current review focuses on the possible current role of antimicrobial impregnated catheters to reduce catheter-related bloodstream infections (CRBSI). There is evidence that the use of chlorhexidine-silver sulfadiazine (CHSS), rifampicin-minocycline, or rifampicin-miconazol impregnated catheters reduce the incidence of CRBSI and costs. In addition, there are some clinical circumstances associated with higher risk of CRBSI, such as the venous catheter access and the presence of tracheostomy. Current guidelines for the prevention of CRBSI recommended the use of a CHSS or rifampicin-minocycline impregnated catheter in patients whose catheter is expected to remain in place > 5 d and if the CRBSI rate has not decreased after implementation of a comprehensive strategy to reduce it.

The Role of Antimicrobial-Impregnated Catheters on Catheter-Related Bloodstream Infection Prevention

Context: The catheterization of a central venous catheter (CVC) may be needed due to different motives. However, that central venous catheterization has different risks such as infection, which leads to morbidity, mortality and assistant costs. Different measures to prevent catheter-related infection have been proposed. Evidence Acquisition: Electronic medical data bases (including PubMed and Scopus) from first of January 1975 to 30th of July 2015 were searched. The key words used for the relevant articles search were catheter, venous, prevention, impregnated, bloodstream, chlorhexidine-silver sulfadiazine, rifampicin-minocycline, and rifampicin-miconazole. This review focuses on the evidence on the efficacy and efficiency of antimicrobial impregnated catheters for the prevention of catheter-related bloodstream infections (CRBSI). Results: The use of catheters impregnated in different antimicrobial agents has been found to be an effective and efficient measure for the prevention of CRBSI. Most antimicrobial agents used for such impregnation have been chlorhexidine silver sulfadiazine (CHSS), rifampicin-minocycline, and rifampicin-miconazole. The use of a CHSS or rifampicin-minocycline impregnated catheter in patients has been recommended by the current guidelines for the prevention of CRBSI when CVC is expected to remain in place for > 5 days and if the CRBSI rate has not decreased after implementation of a comprehensive strategy. Conclusions: Based on the current knowledge, it can be assumed that the use of antimicrobial impregnated catheters could be considered in some clinical circumstances associated with higher risk of CRBSI, such as patients with a CVC in the internal jugular venous site with the presence of tracheostomy or in the femoral venous site.

Chlorhexidine-silver sulfadiazine– or rifampicin-miconazole–impregnated venous catheters decrease the risk of catheter-related bloodstream infection similarly

The objective of this study was to compare the incidence of catheter-related bloodstream infection (CRBSI) with the use of second-generation chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters, rifampicin-miconazole (RM)-impregnated catheters, and standard catheters. Retrospective study of patients admitted to an intensive care unit who received CHSS, RM, or standard catheters in femoral venous access. We diagnosed 18 CRBSIs in 245 patients with standard catheters in 2,061 days, zero CRBSI in 169 patients with CHSS-impregnated catheters in 1,489 days, and zero CRBSI in 227 patients with RM-impregnated catheters in 2,009 days. Patients with standard catheters compared with CHSS- and RM-impregnated catheters showed a higher rate of CRBSI (7.3%, 0%, and 0%, respectively; P < .001) and higher incidence density of CRBSI (8.7, 0, and 0 per 1,000 catheter days, respectively; P < .001). We found in the exact Poisson regression that standard catheters were associated with a higher CRBSI incidence than CHSS-impregnated catheters (P < .001) and RM-impregnated catheters (P < .001), controlling for catheter duration. We found in survival analysis that standard catheters were associated with a lower CRBSI-free time than CHSS-impregnated catheters (P < .001) and RM-impregnated catheters (P < .001). We found that CHSS- and RM-impregnated catheters decreased similarly the risk of CRBSI.

Efficiency of chlorhexidine–silver sulfadiazine-impregnated venous catheters at subclavian sites

Cost-effectiveness analyses show that chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters reduce catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, no studies have reported the efficiency of CHSS-impregnated catheters for venous access when the risk of CRBSI is low; for example, at the subclavian site. This study determined the cost of a CVC, diagnosis of CRBSI, and antimicrobial agents to treat CRBSI; we did not consider the cost of increased hospital stay. This retrospective study included patients admitted to the intensive care unit at Hospital Universitario de Canarias (Tenerife, Spain) who had a subclavian venous catheter. Patients with CHSS catheters (n=353) had a lower incidence density of CRBSI (2.12 vs 0 out of 1,000 catheter-days; P=.02) and lower CVC-related cost per catheter-day (3.35±3.75 vs 3.94±9.95; P=.002) than those with standard catheters (n=518). CHSS-impregnated catheters were associated with a lower risk of CRBSI (exact logistic regression) (odds ratio,0.10; 95% confidence interval,-∞ to 0.667; P=.008) than standard catheters when controlling for catheter duration. CHSS-impregnated catheters were also associated with a lower CVC-related cost per catheter day than standard catheters (Poisson regression) (odds ratio,0.85; 95% confidence interval,0.001-0.873; P<.001). CHSS-impregnated catheters may be efficient in preventing CRBSI in patients with subclavian venous access.

Prevention of transmission of multidrug-resistant organisms during catheter exchange using antimicrobial catheters.

Exchanging a central venous catheter (CVC) over a guide wire for a fresh uncoated CVC in the presence of bacteremia can result in cross-infection of the newly exchanged CVC. A recent retrospective clinical study showed that exchanging a catheter over a guide wire in the presence of bacteremia using an antimicrobial minocycline-rifampin (M/R) catheter may improve outcomes. To expand on this, we developed an in vitro cross-contamination model of exchange to evaluate the efficacy of different antimicrobial CVCs in preventing cross-contamination of multidrug-resistant organisms during exchange. Uncoated CVCs were allowed to form biofilm by methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. After 24 h, the biofilm-colonized CVCs were placed in a glass tube containing bovine calf serum plus Mueller-Hinton broth, and each catheter was exchanged over a guide wire for a fresh uncoated or an M/R-, chlorhexidine-silver sulfadiazine (CHX/SS)-, or chlorhexidine-M/R (CHX-M/R)-coated CVC. Cross-contamination of exchanged catheters was enumerated by sonication and quantitative plating methods. The exchange of M/R CVCs completely prevented cross-contamination by MRSA biofilms compared to control exchanged CVCs (P<0.0001). Exchange with CHX/SS CVCs reduced but did not completely prevent cross-contamination by MRSA (P=0.005). Exchange with CHX-M/R CVCs completely prevented cross-contamination by MRSA, P. aeruginosa, and C. albicans biofilms (P<0.0001). Furthermore, CHX-M/R CVCs were superior to M/R CVCs against P. aeruginosa and C. albicans (P=0.003) and were superior to CHX/SS CVCs against MRSA and P. aeruginosa (P=0.01). In conclusion, exchange with the novel CHX-M/R CVC was the only exchange effective in completely and concurrently preventing cross-contamination from bacteria and Candida.

Chlorhexidine-silver sulfadiazine-impregnated venous catheters save costs

Previous cost-effectiveness analyses have found that the use of chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters is associated with decreased catheter-related bloodstream infections (CRBSI) and central venous catheter (CVC)-related costs. However, in these analyses, the CVC-related cost included the increase of hospital stay. Our aim was to determine the immediate CVC-related cost (including only the cost of CVC, diagnosis of CRBSI, and antimicrobials for the treatment of CRBSI) of using a CHSS or a standard catheter in internal jugular venous access. We performed a prospective, observational, cohort study of patients admitted to the intensive care unit (ICU), Hospital Universitario de Canarias (Tenerife, Spain), who received 1 or more internal jugular venous catheters. The study included 245 CHSS-impregnated catheters and 391 standard catheters. Exact logistic regression analysis showed that CHSS-impregnated catheters were associated with a lower incidence of CRBSI, controlling for catheter duration, than standard catheters (0 vs 5.04 CRBSI per 1,000 catheter-days, respectively; odds ratio, 0.80; 95% confidence interval: 0.712-0.898; P < .001). Poisson regression showed that CHSS-impregnated catheters were associated with lower CVC-related cost per day than standard catheters (€3.78 ± €4.45 vs €7.28 ± €16.71, respectively; odds ratio, 0.52; 95% confidence interval: 0.504-0.535; P < .001). Survival analysis showed that CHSS-impregnated catheters were associated with increased CRBSI-free time compared with standard catheters (χ(2) = 14.9; P < .001). The use of CHSS-impregnated catheters reduced the incidence of CRBSI and immediate CVC-related costs in the internal jugular venous access.

Impact of catheter antimicrobial coating on species-specific risk of catheter colonization: a meta-analysis

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.

Prevention of catheter-related infection: which catheter, which access and which insertion technique should be chosen?

Central venous and arterial catheters are commonly used in critically ill patients. Such catheters may entail mechanical and infectious complications. Catheter-related infections result in a high rate of morbidity and mortality and elevated costs. Numerous contributions have been made in the prevention of catheter-related infections, and the present review focuses on which catheter, which access and which insertion technique should be used. Regarding vascular access, some sites have shown higher risk of catheter-related bloodstream infections (CRBSI), such as the internal jugular site with tracheostomy and the femoral access site. With respect to which catheter should be used, there is evidence that catheters impregnated with rifampicin-(minocycline or miconazole) and chlorhexidine-silver sulfadiazine reduce the risk of CRBSI. These impregnated catheters could be considered in the following circumstances: vascular access channelling with increased risk of CRBSI (such as the internal jugular with tracheostomy or femoral access), immunocompromised patients or patients with disorders of skin integrity. Regarding the choice of insertion technique, there is evidence that ultrasound guidance may decrease cannulation failure and complication rates.

Efficacy of Various Antimicrobial Central Venous Catheters in Mono- and Poly-microbial Environments

One of the CDC 2011 1A recommendations for the prevention of Catheter-Related Bloodstream Infections (CRBSIs) is the use of antimicrobial Central Venous Catheters (CVCs). Mostly, CRBSIs are mono-microbial in nature and are well studied; however, poly-microbial infections, which are more difficult to treat, are less understood. Therefore, this study was designed to evaluate the effectiveness of Chlorhexidine-Silver Sulfadiazine (CH-SSD), Minocycline-Rifampin (MR), and Silver-Carbon-Platinum (SCP) treated CVCs in reducing mono- and poly-microbial colonization's under in vitro conditions.

Prevention of Catheter-Related Blood Stream Infection: Back to Basics?

Central venous catheter (CVC)-related infections are a substantial problem in the intensive care unit (ICU). Our infection control team initiated the routine use of antiseptic-coated (chlorhexidine-silver sulfadiazine; Chx-SS) CVCs in our adult ICUs to reduce catheter-associated (CA) and catheter-related (CR) blood stream infection (BSI) as we implemented other educational and best practice standardization strategies. Prior randomized studies documented that the use of Chx-SS catheters reduces microbial colonization of the catheter compared with an uncoated standard (Std) CVC but does not reduce CR-BSI. We therefore implemented the routine use of uncoated Std CVCs in our surgical ICU (SICU) and examined the impact of this change. The use of uncoated Std CVCs does not increase CR-BSI rate in an SICU. Prospective evaluation of universal use of uncoated Std CVCs, implemented November 2007 in the SICU. The incidences of CA-BSI and CR-BSI were compared during November 2006-October 2007 (universal use of Chx-SS CVCs) and November 2007-October 2008 (universal use of Std CVCs) by t-test. The definitions of the U.S. Centers for Disease Control and Prevention were used for CA-BSI and CR-BSI. Patient data were collected via a dedicated Acute Physiology and Chronic Health Evaluation (APACHE) III coordinator for the SICU. Annual use of CVCs increased significantly in the last six years, from 3,543 (2001) to 5,799 (2006) total days. The APACHE III scores on day 1 increased from a mean of 54.4 in 2004 to 55.6 in 2008 (p = 0.0010; 95% confidence interval [CI] 1.29-5.13). The mean age of the patients was unchanged over this period, ranging from 58.2 to 59.6 years. The Chx-SS catheters were implemented in the SICU in 2002. Data regarding the specific incidence of CR-BSI were collected beginning at the end of 2005, with mandatory catheter tip cultures when CVCs were removed. Little difference was identified in the incidence of BSI between the interval with universal Chx-SS use and that with Std CVC use. (Total BSI 0.7 vs. 0.8 per 1,000 catheter days; CA-BSI 0.5 vs. 0.8 per 1,000 catheter days; CR-BSI 0.2 vs. 0 per 1,000 catheter days.) No difference was seen in the causative pathogens of CA-BSI or CR-BSI. Eliminating the universal use of Chx-SS-coated CVCs in an SICU with a low background incidence of CR-BSIs did not result in an increase in the rate of CR-BSIs. This study documents the greater importance of adherence to standardization of the processes of care related to CVC placement than of coated CVC use in the reduction of CR-BSI.

Selection of the vascular catheter: can it minimise the risk of infection?

Data regarding the prevention of catheter-related bloodstream infection (CRBSI) by making the correct decisions about when to place a central line, the appropriate selection of catheter composition and the size and number of lumens, a suitable choice of insertion site and the technique used are not well reported in recent medical literature. There is no clear evidence that the composition of the catheters presently on the market makes a significant difference to the risk of infection. Several prospective studies suggest that femoral vein location represents the highest risk of infection, followed by jugular vein and subclavian vein positioning, however, most articles do not correct for basic confounding variables. Several papers have reported that arterial catheters have a similar risk of infection as central venous catheters (CVCs). The slight increase in infection risk when using multi-lumen catheters is probably offset by their improved convenience. Current evidence does not support routine tunnelling of short-term catheters until its efficacy is evaluated at different placement sites, using specific catheters and situations and in relation to other preventive interventions. Cuffing is usually applied only to long-term tunnelled catheters. The available evidence suggests that chlorhexidine–silver sulfadiazine, minocycline–rifampicin CVCs and antifungal-coated catheters are useful in decreasing the incidence of CRBSI when other measures are not effective.

Antimicrobial and antibiofilm efficacy of triclosan and DispersinB(R) combination

The objectives of this study were to examine: (i) synergy of the combination of triclosan and DispersinB (DspB); (ii) in vitro efficacy and durability of triclosan + DspB-coated vascular catheters; and (iii) in vivo efficacy of triclosan + DspB-coated catheters compared with chlorhexidine-silver sulfadiazine (CH-SS)-coated and uncoated (control) vascular catheters in preventing colonization by Staphylococcus aureus. We investigated the potential synergistic antimicrobial and antibiofilm activity of triclosan and DspB by biofilm assays. The in vitro antimicrobial efficacy of triclosan + DspB-coated catheters was determined by microbial colonization assays. Antimicrobial durability of the coated catheters was tested by soaking segments in bovine serum for 7 days and determining antimicrobial activity, and by a serial plate transfer method. The in vivo efficacy of triclosan + DspB-coated catheters compared with CH-SS-coated and uncoated catheters was assessed by subcutaneous implantation of segments in a rabbit model of S. aureus infection. The combination of triclosan and DspB showed synergistic antimicrobial and antibiofilm activity against S. aureus, Staphylococcus epidermidis and Escherichia coli, significantly reduced bacterial colonization (P < 0.05) and generally demonstrated a prolonged superior antimicrobial activity against clinical pathogens compared with CH-SS-coated catheters. Triclosan + DspB-coated and CH-SS-coated catheters exhibited equal in vivo efficacy (P <or= 0.05) in reducing colonization by S. aureus compared with uncoated catheters. Catheters coated with the triclosan + DspB combination showed synergistic, broad-spectrum and durable antimicrobial activity. Furthermore, the in vivo efficacy of catheters coated with this unique antimicrobial/antibiofilm composition prompts clinical evaluation of such an innovative approach.

The effectiveness of chlorhexidine-silver sulfadiazine impregnated central venous catheters in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation

Immuno-compromised patients are at high risk for all kind of infections. Unfortunately, they need central venous catheters (CVCs), which are associated with infectious complications. In this study we examined the effectiveness of chlorhexidine-silver sulfadiazine impregnated CVCs to prevent catheter-related infections in patients receiving high-dose chemotherapy followed by peripheral stem cell transplantation. This historical cohort study evaluated 139 patients of whom 70 patients were provided with non-impregnated CVCs and 69 patients with impregnated CVCs. Patients were treated for different diagnoses. The median number of days a CVC stayed in situ was 18 in the non-impregnated group and 16 in the impregnated group. The median duration of neutropenia of patients with non-impregnated CVCs was 9 days compared with 7 days of patients with impregnated CVCs. We found less catheter colonization (CC) in patients with chlorhexidine-silver sulfadiazine CVCs (RR 0.63, 95% CI 0.41-0.96; P = 0.03). Catheter-related blood stream infections (CR-BSI) were also diminished, but this result was not statistically significant (RR 0.15, 95% CI 0.02-1.15; P = 0.06). The reduction in CC and CR-BSI did not diminish the incidence of fever. We conclude that the use of chlorhexidine-silver sulfadiazine impregnated CVCs provide an important improvement in the attempt to reduce CC and CR-BSI.

Central Venous Catheter Colonization in Critically Ill Patients: A Prospective, Randomized, Controlled Study Comparing Standard with Two Antiseptic-Impregnated Catheters

In this prospective, randomized, controlled, unblinded study, we compared colonization rates of a standard, unimpregnated central venous catheter (CVC) with rates for silver-coated and chlorhexidine-silversulfadiazine (CH-SS)-impregnated CVC. Patient characteristics, CVC insertion site, indwelling time, and colonization detected by semiquantitative and quantitative microbiologic techniques were documented. Two-hundred-seventy-five critically ill patients were included into the study protocol. One-hundred-sixty standard, 160 silver (S)-coated, and 165 externally impregnated CH-SS CVC were inserted. There was a significant difference in CVC colonization rates among study groups (P = 0.029). There was no difference in the colonization rate and the colonization per 1000 catheter days between standard and S-coated (P = 0.564; P = 0.24) or CH-SS-coated CVC (P= 0.795; P = 0.639). When comparing antiseptic CVC with each other, colonization rates were significantly less with CH-SS-impregnated than with S-coated CVC (16.9% versus 7.3%; P = 0.01; 18.2 versus 7.5 of 1000 catheter days; P = 0.003; relative risk, 0.43; 95% confidence interval, 0.21-0.85). Whereas standard and S-coated CVC were first colonized 2 and 3 days after insertion, respectively, CH-SS CVC were first colonized only after 7 days. In conclusion, antiseptic-impregnated CVC could not prevent catheter colonization when compared with standard polyurethane catheters in a critical care setting with infrequent catheter colonization rates and CVC left in place for >10 days.

Effect of a Second-Generation Venous Catheter Impregnated with Chlorhexidine and Silver Sulfadiazine on Central Catheter–Related Infections

Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed. To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. Multicenter, randomized, double-blind, controlled trial. 9 university-affiliated medical centers. 780 patients in intensive care units who required central venous catheterization. Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. The antiseptic catheter was not compared with an antibiotic-coated catheter, and no conclusion can be made regarding its effect on bloodstream infection. The second-generation chlorhexidine-silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.

The Central Venous Catheter-related Infection of Chlorhexidine-silver Sulfadiazine Coated Catheters in Medical ICU

Background : Central venous catheters(CVCs) area major source of nosocomial infection. Chlorhexidine-silver sulfadiazine coated catheters (CHSS) were developed to reduce the rate of CVC infection. However, the clinical effectiveness of CHSS in comparison wth non-coated catheter (NCC) remains to be evaluated. Methods : From January 2004 to December 2004 in medical intensive care unit (ICU) of Asan Medical Center, CVCs were inserted in 446 cases. We retrospectively analyzed characteristics of patients and catheterization,the catheter-related infection rate and colonization, microbiologic findings, and insertion sites (subclavian, jugular, femoral) according to the type of inserted CVCs (NCC: 187 cases, CHSS: 259 cases). Catheter related infection is defined as catheter related bacteremia and catheter related non-bacteremic sepsis. Results : 1) The mean age of the patients in each group was years, years (p=0.42), and sex ratio 94:50, 141:69 (p=0.9) in NCC and CHSS. Duration of ICU admission (, p=0.42), duration of mechanical ventilation (, p=0.17), and APACHE III score at the time of CVC insertion (, p=0.61) were not different between both groups. 2) Mean duration of catheterization was 118 in NCC and 119 in CHSS (p=0.98). Number of catheter-days was 2176 days in NCC and 3035 days in CHSS. Catheter-related infection occurred in 9 (4.8%) cases receiving NCC and 4 cases (1.5%) receiving CHSS. Catheterrelated infection incidence per 1000 catheter-days was 4.1 and 1.3, respectively (p=0.04). CHSS was associated with a significant reduction of infection in jugular catheters regarding to insertion sites (p=0.01). 3) Microorganisms causing infection were Staphylococcus aureus (n=3), Candida (n=3), coagulase-negative Staphylococci (n=2), and Klebsiella (n=1) in NCC, and Candida species (n=2), coagulase-negative Staphylococci (n=2), Proteus (n=1) in CHSS. Conclusion : CHSS has significantly reduced the episodes of infection compared to NCC in jugular catheterization in medical ICU.

Antimicrobial/Anti-infective Catheters: Comparison of BSI Rates in a Community Hospital

BACKGROUND: Missouri Baptist Medical Center is a 499-bed community hospital with 30 ICU beds and approximately 92,281 patient days per year. Primary bloodstream infection (BSI) rates are monitored in the intensive care unit (ICU) and range from 3.09/1000 to 16.19/1000 central line days (CLD). In 2001 a study was initiated to compare BSI rates among patients with anti-infective (chlorhexidine- and silver-sulfadiazine-coated) catheters versus those with anti-microbial (minocycline and rifampin)-coated catheters. METHODS: The quasi-experimental study included patients from ICU and general patient-care areas (PCA) with multi-lumen catheters. Anti-infective catheters were used during the Phase I of the study from January through June, and anti-microbial catheters were used during the Phase II of the study from July through December. Patients excluded from the study were those with 1 and 4 lumens, those with dialysis catheters, and those with catheters placed by guidewire exchange. BSI rates, line duration, and time to infection were compared by univariate analysis to determine if implementation of antimicrobial catheters decreased infection rates. RESULTS: During the study period, 27 patients developed BSI. Fifteen of the 27 cases were excluded from the study. The BSI rate for the entire study period was 4.79/1000 CLD. BSI rate for Phase I was 4.81, and 4.78 for Phase II. There was no statistically significant difference noted. BSI rates were higher in ICU patients compared to patients in PCA (7.89 and 1.62/1000 CLD, respectively). No statistical difference was found for line duration or time to infection among the catheter types. In all, infected cases the lines were placed in either the subclavian or internal jugular veins. CONCLUSION: There were no statistical differences in BSI rates between Phase I and Phase II. Limitations of the study included sample size bias, which impeded our ability to detect differences in rates due to inadequate power. Although the study was conducted for a full year, the small numbers of infections made it difficult to demonstrate statistical significance. Literature has shown that the use of central venous catheters impregnated with minocycline and rifampin are associated with lower rates of colonization than those coated with chlorhexidine silver sulfadiazine. However these findings were not duplicated in our study.