Intensive Care Medicine

, Volume 30, Issue 5, pp 837–843 | Cite as

Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled trial

  • Christian Brun-Buisson
  • Françoise Doyon
  • Jean-Pierre Sollet
  • Jean-François Cochard
  • Yves Cohen
  • Gérard Nitenberg
Original

Abstract

Background

The indication of antiseptic-coated catheters remains debated.

Objective

To test the ability of the new generation of chlorhexidine-silver and sulfadiazine-coated catheters, with enhanced antiseptic coating, to reduce the risk of central venous catheter (CVC)-related infection in ICU patients.

Design

Multicentre randomized double-blind trial.

Patients and setting

A total of 397 patients from 14 ICUs of university hospitals in France.

Intervention

Patients were randomized to receive an antiseptic-coated catheter (ACC) or a standard non-coated catheter (NCC).

Measurements

Incidence of CVC-related infection.

Results

Of 367 patients having a successful catheter insertion, 363 were analysed (175 NCC and 188 ACC). Patients had one (NCC=162, ACC=180) or more (NCC=13, ACC=11) CVC inserted. The two groups were similar for insertion site [subclavian (64 vs 69)] or jugular (36 vs 31%)], and type of catheters (single-lumen 18 vs 18%; double-lumen 82 vs 82%), and mean (median) duration of catheterisation [12.0±11.7 (9) vs 10.5±8.8 (8) days in the NCC and ACC groups, respectively]. Significant colonisation of the catheter occurred in 23 (13.1%) and 7 (3.7%) patients, respectively, in the NCC and ACC groups (11 vs 3.6 per 1000 catheter-days; p=0.01); CVC-related infection (bloodstream infection) occurred in 10 (5) and 4 (3) patients in the NCC and CC groups, respectively (5.2 vs 2 per 1000 catheter days; p=0.10).

Conclusions

In the context of a low baseline infection rate, ACC were associated with a significant reduction of catheter colonisation and a trend to reduction of infection episodes, but not of bloodstream infection.

Keywords

Intensive care Catheter-associated infection Bacteraemia Prevention Antiseptics 

Supplementary material

supp.pdf (73 kb)
Supplementary Material (PDF 74 KB)

References

  1. 1.
    Pittet D, Li N, Woolson RF, Wenzel RP (1997) Microbiological factors influencing the outcome of nosocomial bloodstream infections: a 6-year validated, population-based model. Clin Infect Dis 24:1068–1078PubMedGoogle Scholar
  2. 2.
    Renaud B, Brun-Buisson C, the ICU-Bacteremia Study Group (2001) Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients. Am J Respir Crit Care Med 163:1584–1590Google Scholar
  3. 3.
    Maki DG (1981) Nosocomial bacteremia. An epidemiologic overview. Am J Med 70:719–732PubMedGoogle Scholar
  4. 4.
    Pittet D, Tarara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality. J Am Med Assoc 271:1598–1601CrossRefGoogle Scholar
  5. 5.
    Mermel LA (2000) Prevention of intravascular catheter-related infections. Ann Intern Med 132:391–402 (errata in Ann Intern Med 2000, 133:395)Google Scholar
  6. 6.
    Pittet D, Tarara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. J Am Med Assoc 271:1598–1601CrossRefGoogle Scholar
  7. 7.
    O’Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A et al. (2002) Guidelines for the prevention of intravascular catheter-related infections. Centers for Disease Control and Prevention. MMWR Recomm Rep 51:1–29Google Scholar
  8. 8.
    Crnich CJ, Maki DG (2002) The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis 34:1232–1242CrossRefPubMedGoogle Scholar
  9. 9.
    Maki DG, Stolz SM, Wheeler SJ, Mermel LA (1997) Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 127:257–266PubMedGoogle Scholar
  10. 10.
    Marin MG, Lee JC, Skurnick JH (2000) Prevention of nosocomial bloodstream infections: effectiveness of antimicrobial-impregnated and heparin-bonded central venous catheters. Crit Care Med 28:3332–3338Google Scholar
  11. 11.
    Veenstra DL, Saint S, Saha S, Lumley T, Sullivan SD (1999) Efficacy of antiseptic-impregnated central venous catheters in preventing catheter-related bloodstream infection: a meta-analysis. J Am Med Assoc 281:261–267CrossRefGoogle Scholar
  12. 12.
    Veenstra DL, Saint S, Sullivan SD (1999) Cost-effectiveness of antiseptic-impregnated central venous catheters for the prevention of catheter-related bloodstream infection. J Am Med Assoc 282:554–560CrossRefGoogle Scholar
  13. 13.
    McConnell SA, Gubbins PO, Anaissie EJ (2004) Do antimicrobial-impregnated central venous catheters prevent catheter-related bloodstream infection? Clin Infect Dis 37:65–72CrossRefGoogle Scholar
  14. 14.
    Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, Berg J, Khardori N, Hanna H, Hachem R, Harris RL, Mayhall G (1999) A comparison of two antimicrobial-impregnated central venous catheters. N Engl J Med 340:1–8PubMedGoogle Scholar
  15. 15.
    Raad II, Hohn DC, Gilbreath J, Suleiman N, Hill LA, Brusco PA, Marts K, Mansfield PF, Bodey GP (1994) Prevention of central venous catheter-related infection by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 15:231–238PubMedGoogle Scholar
  16. 16.
    Bone RC, Balk RA, Cerra FB, Dellinger EP, Fein AM, Knaus WA, Schein RM, Sibbald WJ, the ACCP/SCCM Consensus Conference Committee (1992) Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. Chest 101:1656–1662PubMedGoogle Scholar
  17. 17.
    Cleri DJ, Corrado ML, Seligman SJ (1980) Quantitative cultures of intravenous catheters and other intravascular inserts. J Infect Dis 141:781–786PubMedGoogle Scholar
  18. 18.
    Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M (1987) Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 147:873–877PubMedGoogle Scholar
  19. 19.
    Raad II, Bodey GP (1992) Infectious complications of indwelling vascular catheters. Clin Infect Dis 15:197–210PubMedGoogle Scholar
  20. 20.
    Armstrong CW, Mayhall CG, Miller KB, Newsome HHJ, Sugerman HJ, Dalton HP, Hall GO, Gennings C (1986) Prospective study of catheter replacement and other risk factors for infection of hyperalimentation catheters. J Infect Dis 154:808–816PubMedGoogle Scholar
  21. 21.
    Bach A, Schmidt H, Böttiger B, Schreiber B, Böhrer H, Motsch J, Martin E, Sonntag HG, Bottiger B, Bohrer H (1996) Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J Antimicrob Chemother 37:315–322PubMedGoogle Scholar
  22. 22.
    Centers for DIsease Control (2000) Nosocomial Infections Surveillance Activity, Hospital Infection Program, National Center for Infectious Diseases. Monitoring hospital-acquired infections to promote patient safety—United States, 1990–1999. Morb Mortal Wkly Rep 49:149–153Google Scholar
  23. 23.
    Sampath LA, Tambe SM, Modak SM (2001) In vitro and in vivo efficacy of catheters impregnated with antiseptics or antibiotics: evaluation of the risk of bacterial resistance to the antimicrobials in the catheters. Infect Control Hosp Epidemiol 22:640–646PubMedGoogle Scholar
  24. 24.
    Rupp ME, Lisco S, Lipset P, Perl T, Keating K, Mermel LA, Lee D, Dellinger EP, Donahoe M, Giles D, Pfaller MA, Sherertz RJ (2001) Effect of chlorhexidine/silver sulfadiazine coating on microbial colonization of central venous catheters in a multicenter trial. Abstract of the ICCACGoogle Scholar
  25. 25.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European-North American multicenter study. J Am Med Assoc 270:2957–2963CrossRefGoogle Scholar
  26. 26.
    Le Gall JR, Klar J, Lemeshow S, Saulnier F, Alberti C, Artigas A, Teres D, The ICU Scoring Group (1996) The logistic organ dysfunction system: a new way to assess organ dysfunction in the intensive care unit. J Am Med Assoc 276:802–810CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Christian Brun-Buisson
    • 1
  • Françoise Doyon
    • 2
  • Jean-Pierre Sollet
    • 3
  • Jean-François Cochard
    • 4
  • Yves Cohen
    • 5
  • Gérard Nitenberg
    • 6
  1. 1.Réanimation MédicaleHôpital Henri Mondor (AP-HP)Créteil CedexFrance
  2. 2.Unité Inserm U 521Institut Gustave RoussyVillejuifFrance
  3. 3.Réanimation PolyvalenteHôpital Victor DupouyArgenteuilFrance
  4. 4.Réanimation ChirurgicaleHôpital PellegrinBordeauxFrance
  5. 5.Réanimation PolyvalenteHôpital AvicenneBobignyFrance
  6. 6.Réanimation PolyvalenteInstitut Gustave RoussyVillejuifFrance

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