title: Central venous catheters revisited--infection rates and an assessment of the new Fibrin Analysing System brush.
abstract: Sixty-one consecutive patients in the Intensive Care Unit requiring central venous lines (CVC) for five or more days were randomized to receive either a standard triple lumen CVC (STD/CVC) or a silver sulphadiazine and chlorhexidine impregnated CVC (SSD/CVC). Data from the 54 patients who completed the trial show a reduced infection rate (positive tip culture) in the SSD/CVC group (4 out of 28) compared to the STD/CVC group (10 out of 26) (P < 0.05). In addition, the new Fibrin Analysing System (FAS) brush was evaluated and used to determine the presence of infection in all the CVCs (STD/CVC and SSD/CVC combined, n = 54) at day 3 (i.e. early warning of CVC colonization/infection) and at the time of removal of the CVC. The FAS brush was able to detect an infected CVC on only one occasion on day 3 out of the 14 CVC tips which were later found to be colonized/infected at the time of removal. The sensitivity of the FAS brush in detecting colonized/infected CVCs at the time of CVC removal compared with CVC tip culture was 21% with a specificity of 100%. These findings would currently not support the routine use of the FAS brush in determining CVC infection/colonization.
authors.affiliation: Department of Intensive Care, Sir Charles Gairdner Hospital, Perth, W.A.
authors.forename: P V
authors.initials: PV
authors.lastname: van Heerden
authors.forename: S A
authors.initials: SA
authors.lastname: Webb
authors.forename: S
authors.initials: S
authors.lastname: Fong
authors.forename: C L
authors.initials: CL
authors.lastname: Golledge
authors.forename: B L
authors.initials: BL
authors.lastname: Roberts
authors.forename: W R
authors.initials: WR
authors.lastname: Thompson
mesh_terms: D000150:Acinetobacter / Q000302:isolation & purification; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D001424:Bacterial Infections / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002710:Chlorhexidine / Q000627:therapeutic use; D004867:Equipment Design; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D013212:Staphylococcus epidermidis / Q000302:isolation & purification
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D012837:Silver Sulfadiazine