Infection

, Volume 27, Supplement 1, pp S56–S60 | Cite as

Reduced rates of catheter-associated infection by use of a new silver-impregnated central venous catheter

  • M. Böswald
  • S. Lugauer
  • A. Regenfus
  • G. G. Braun
  • P. Martus
  • C. Geis
  • S. Scharf
  • T. Bechert
  • J. Greil
  • J. -P. Guggenbichler

Summary

A central venous catheter with a new form of silver impregnation of the internal and external surfaces was investigated for antimicrobial activity and tolerance in patients in a controlled comparative, prospective and randomized clinical study. Commercially available catheters with no antimicrobial activity were used as controls. One hundred sixty-five catheters were included in the final evaluation. All catheters were percutaneously inserted for the first time with a duration of ≥5 days and a microbiological examination of the catheter tip. Catheter location (>90% internal jugular vein), mean duration of catheterization (8–9 days), patients' age and diagnosis were comparable in both groups. Silver-impregnated catheter tips showed an incidence of colonization in 14.2/1000 catheter days and control catheters in 22.8/1000 catheter days. This represents a reduction of 37.7%. Catheter-associated infections were diagnosed in the silver group in 5.26/1000 catheter days and 18.34/1000 catheter days in the control group, indicating a reduction rate of 71.3% (P<0.05, χ2-test). No complications or side effects were documented in either group.

References

  1. 1.
    Maki, D. G.: Nosocomial bacteremia. An epidemiologic overview. Am. J. Med. 70 (1981) 183–196.CrossRefGoogle Scholar
  2. 2.
    Maki, D. G.: Pathogenesis, prevention, and management of infections due to intravascular devices used for infusion therapy. In:Bisno, A. L., Waldvogel, F. A. (eds). Infections associated with indwelling medical devices. American Society for Microbiology, Washington, D. C., 1994, pp. 161–177.Google Scholar
  3. 3.
    Widmer, A. F.: IV-related infections. In:Wenzel, R. P. (ed.): Nosocomial infections. Williams & Wilkins, Baltimore, 1993, pp. 556–579.Google Scholar
  4. 4.
    Pittet, D.: Nosocomial bloodstream infections. In:Wenzel, R. P. (eds): Nosocomial infections, Williams & Wilkins, Baltimore 1993, pp. 512–555.Google Scholar
  5. 5.
    Gastmeier, P., Weist, K., Rüden, H.: Catheter-associated primary bloodstream infections: epidemiology and preventive methods. Infection 27 (Suppl. 1) (1999) S 1–6.Google Scholar
  6. 6.
    Pittet, D., Tarara, D., Wenzel, R. P.: Nosocomial bloodsteam infections in critically ill patients. Excess length stay, extra costs, and attributable mortality. JAMA 272 (1994) 1819–1820.CrossRefGoogle Scholar
  7. 7.
    Faubion, W. C., Wesley, J. R., Khalidi, N., Silva, J.: Total parenteral nutrition catheter sepsis: impact of the team approach. J. Parenter. Enteral Nutr. 10 (1986) 642–645.CrossRefGoogle Scholar
  8. 8.
    Freeman, J. B., Lemire, A., MacLean, L. D.: Intravenous alimentation and septicemia. Surg. Gynecol. Obstet. 135 (1972) 708–712.PubMedGoogle Scholar
  9. 9.
    Frank, U., Eisenbeis, S., Daschner, F.: Beurteilung verschiedener Verbandstechniken zur Verhütung von Infektionen durch zentrale Venenkatheter: Fixomull-Klebevlies. Tegaderm-Folienverband, Nobecutan-Sprühfilm. Intensivmed. 25 (1988) 187–191.Google Scholar
  10. 10.
    Maple, P. A. C., Hamilton-Miller, J. M. T., Brumfitt, W.: Comparison of thein vitro activities of the topical antimicrobials azelaic acid, nitrofurazone, silver sulphadiazine and mupirocin against methicillin-resistantStaphylococcus aureus. J. Antimicrob. Chemother. 29 (1992) 661–668.PubMedCrossRefGoogle Scholar
  11. 11.
    Norden, C. W.: Application of antibiotic ointment to the site of venous catheterization—a controlled trial. J. Infect. Dis. 120 (1969) 611–615.PubMedGoogle Scholar
  12. 12.
    Illner, H., Hsia, W. C., Rikert, S. L., Tran, R. M., Straus, D.: Use of topical antiseptic in prophylaxis of catheter-related septic complications. Surg. Gynecol. Obstet 168 (1989) 481–490.PubMedGoogle Scholar
  13. 13.
    Schwartz, C., Henrickson, K., Roghman, K., Powell, K.: Prevention of bacteremia attributed to luminal colonization of tunneled central venous catheters with vancomycin susceptible organisms. J. Clin. Oncol. 8 (1991) 1591–1597.Google Scholar
  14. 14.
    Raad, I., Darouiche, R., Dupuis, J., Abi-Said, D., Gabreilli, A., Hachem, R., Wall, M., Harris, R., Jones, J., Buzaid, A., Robertson, C., Shenaq, S., Curling, P., Burke, T., Ericsson, C.: Gentral venous catheters coated with minocycline and rifampin for the prevention of catheter related colonization and bloodstream infections. Ann. Intern. Med. 127 (1997) 267–274.PubMedGoogle Scholar
  15. 15.
    Schierholz, J. M., Pulverer, G., Rump, A. F. E.: Kathetermaterialien: Schwierige Suche nach neuen Werkstoffen. Dtsch. Ärzteblatt 95 (1998) 813–815.Google Scholar
  16. 16.
    Bach, A., Böhrer, H.: Infektionen durch intravasale Katheter. Anästhesiol. Intensivmed. Notfallmed. Schmerzther. 28 (1993) 404–414.Google Scholar
  17. 17.
    Bach, A.: Prevention of infections caused by central venus catheter— established and novel measures. Infection 27 Suppl. 1 (1999) S 11–15.Google Scholar
  18. 18.
    Guggenbichler, J.-P., Böswald, M.;Lugauer, S., Krall, T.: A new technology of microdispersed silver in polyurethane induces antimicrobial activity in central venous catheters. Infection 27 (Suppl. 1) (1999) S 16–23.Google Scholar
  19. 19.
    Kamal, G. D., Pfaller, M. A., Rempe, L. E., Jebson, P. J.: Reduced intravascular catheter infection by antibiotic bonding. A prospective, randomized, controlled trial. JAMA 265 (1991) 2364–2368.PubMedCrossRefGoogle Scholar
  20. 20.
    Raad, I., Darouche, R., Hachem, R., Mansouri, M., Bodey, G. P.: The broad-spectrum activity and efficacy of catheters coated with minocycline and rifampin. J. Infec. Dis. 173 (1996) 418–424.Google Scholar
  21. 21.
    Böswald, M., Girisch, M., Greil, J., Spies, T., Stehr, K., Krall, T., Guggenbichler, J.-P.: Antimicrobial activity and biocompatibility of polyurethane and silicone catheters containing low concentrations of silver: a new perspective in prevention of polymer-associated foreign-body infections. Zbl. Bakt. 283 (1995) 187–200.Google Scholar
  22. 22.
    Bechert, T., Böswald, M., Lugauer, S., Regenfus, A., Greil, J., Guggenbichler, J.-P.: The Erlanger silver catheter:in vitro results for antimicrobial activity. Infection 27 (Suppl 1) (1998) S 24–29.Google Scholar
  23. 23.
    Joyce-Wöhrmann, R. M., Münstedt, H.: Determination of the silver ion release from polyurethanes enriched with silver. Infection 27 (Suppl. 1) (1999) S 46–48.Google Scholar
  24. 24.
    Hentschel, T., Münsted, H.: Thermoplastic polyurethane—the material used for the Erlanger silver catheter. Infection 27 (Suppl. 1) (1999) S 43–45.Google Scholar
  25. 25.
    Böswald, M., Lugauer, S., Bechert, T., Greil, J., Regenfus, A., Guggenbichler, J.-P.: Thrombogenicity testing of central venous cathetersin vitro. Infection 27 (Suppl. 1) (1999) S 30–33.Google Scholar
  26. 26.
    Greil, J., Spies, T., Böswald, M., Bechert, T., Lugauer, S., Regenfus, A., Guggenbichler, J.-P.: Analysis of the acute cytotoxicity of the Erlanger silver catheter. Infection 27 (Suppl. 1) (1999) S 34–37.Google Scholar
  27. 27.
    Böswald, M., Mende, K., Bernschneider, W., Bonakdar, S., Ruder, H., Kissler, K., Sieber, E., Guggenbichler, J.-P.: Bicompatibility testing of a new silver impregnated catheterin vivo. Infection 27 (Suppl. 1) (1999) S 38–42.Google Scholar
  28. 28.
    Martus, P., Geis, C., Lugauer, S., Böswald, M., Guggenbichler, J.-P.: Clinical study of the Erlanger silver catheter—data management and biometry. Infection 27 (Suppl. 1) (1999) S 61–68.Google Scholar
  29. 29.
    Klaus, G., Schaefer, F., Müller-Wiefel, D. E., Mehls, O.: Treatment of peritoneal-dialysis associated peritonitis with continuous versus intermittent vancomycin/teicoplanin and ceftazidime in children: preliminary results of a prospective randomized trial. Adv. Perit. Dial. 11 (1995) 296–301.PubMedGoogle Scholar
  30. 30.
    Maki, D. G., Weise, C. E., Sarafin, H. W.: A semiquantitative culture method for identifying intravenous catheter-related infection. N. Engl. J. Med. 296 (1977) 1305–1309.PubMedCrossRefGoogle Scholar
  31. 31.
    Schoerner, C., Lugauer, S., Regenfus, A.: Silver catheter study: methods and results of microbiological investigations. Infection 27 (Suppl. 1) (1999) S 54–55.Google Scholar
  32. 32.
    Centers for Disease Control and Prevention: Draft guidelines for prevention of intravascular device-related infections; Part 1: Intravascular device-related infections: an overview; Part 2: Recommendations for prevention of intravascular device-related infections: notice of comment period. Federal Register 60 (1995) 49978–50006.Google Scholar
  33. 33.
    Pearson, M. L.: The hospital infection control practices advisory committee. Guideline for prevention of intravascular device-related infections. Am. J. Infect. Control 24 (1996) 262–293.PubMedCrossRefGoogle Scholar
  34. 34.
    Lugauer, S., Regenfus, A., Böswald, M., Martus, P., Geis, C., Bechert, T., Greil, J., Guggenbichler, J. P.: A new scoring system for the clinical diagnosis of catheter-related infections. Infection 27 (Suppl. 1) (1999) S 49–53.Google Scholar
  35. 35.
    Maki, D. G., Stolz, S. M., Wheeler, S. J., Mermel, L. A.: Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. Ann. Intern. Med. 127 (1997) 257–266.PubMedGoogle Scholar
  36. 36.
    Bach, A., Böhrer, H., Motsch, J., Martin, E., Geiss, H. K., Somntag, H. G.: Prevention of bacterial colonization of intravenous catheters by antiseptic impregnation of polyurethane polymers. J. Antimicrob. Chemother. 33 (1994) 969–978.PubMedCrossRefGoogle Scholar
  37. 37.
    Bach, A., Schmidt, H., Böttiger, B., Schreiber, B., Böhrer, H., Motsch, J., Martin, E., Sonntag, H. G.: Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J. Antimicrob. Chemother. 37 (1996) 315–322.PubMedCrossRefGoogle Scholar
  38. 38.
    Ciresi, D. L., Albrecht, R. M., Volkers, P. A., Scholten, D. J.: Failure of antiseptic bonding to prevent central venous catheter-related infection and sepsis. Am. Surg. 62 (1996) 641–646.PubMedGoogle Scholar
  39. 39.
    Civetta, J. M., Hudson-Civetta, J., Ball, S.: Decreasing catheter-related infection and hospital costs by continuous quality improvement. Crit. Care Med. 24 (1996) 1660–1665.PubMedCrossRefGoogle Scholar
  40. 40.
    Greenfield, J. I., Sampath, L., Popilskis, S. J., Brunnert, S. R., Stylianos, S., Modak, S.: Decreased bacterial adherence and biofilm formation on chlorhexidine and silver sulfadiazine-impregnated central venous catheters implanted in swine. Crit. Care Med. 23 (1995) 894–900.CrossRefGoogle Scholar
  41. 41.
    Pemberton, L. B., Ross, V., Cuddy, P., Kremer, H., Fessler, T., McGurk, E.: No difference in catheter sepsis between standard and antiseptic central venous catheters. Arch Surg. 131 (1996) 986–989.PubMedGoogle Scholar
  42. 42.
    Ramsay, J., Nolte, F., Schwarzmann, S.: Incidence of catheter colonization and catheter related infection with an antiseptic impregnated triple lumen catheter (abstr.). Crit. Care Med. 22 (1993) A115.CrossRefGoogle Scholar
  43. 43.
    Sherertz, R. J., Heard, S. O., Raad, I. I., Gentry, L., Bowton, D., Scuderi, P., Hu, J., Carruth, W., Satishchandra, B., Pepe, J., Mosenthal, A., Burke, T., Dupuis, J.: Gamma radiation-sterilized, triple-lumen catheters coated with a low concentration of chlorhexidine were not efficacious at preventing catheter infections in intensive care unit patients. Antimicrob. Agents Chemother. 40 (1996) 1995–1997.PubMedGoogle Scholar
  44. 44.
    Ellis, M. E., Rhydderch, D., Zwaan, F., Guy, M. L., Baillie, F.: High incidence of line-related infection and mechanical failure of an antiseptic impregnated central venous catheter in highly immunocompromised patients. Scand. J. Infect. Dis. 28 (1996) 91–93.PubMedGoogle Scholar
  45. 45.
    Goldschmidt, H., Hahn, U., Salwender,H. J., Haas, R., Jansen, B., Wolbring, P., Rinck, M., Hunstein, W.: Prevention of catheter-related infections by silver coated central venous catheters in oncological patients. Zentralbl. Bakteriol. 283 (1995) 215–223.PubMedGoogle Scholar

Copyright information

© MMV Medien & Medizin Verlags GmbH 1999

Authors and Affiliations

  • M. Böswald
    • 1
  • S. Lugauer
    • 1
  • A. Regenfus
    • 1
  • G. G. Braun
    • 2
  • P. Martus
    • 3
  • C. Geis
    • 3
  • S. Scharf
    • 1
  • T. Bechert
    • 1
  • J. Greil
    • 1
  • J. -P. Guggenbichler
    • 1
  1. 1.Klinik mit Poliklinik für Kinder und Jugendliche der Friedrich-Alexander-Universität Erlangen-NürnbergErlangenGermany
  2. 2.Klinik für Anästhesiologie der Friedrich-Alexander-Universität Erlangen-NürnbergErlangenGermany
  3. 3.Institut für Medizinische Statistik und Dokumentation der Friedrich-Alexander-Universität Erlangen-NürnbergErlangenGermany

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