title: Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial.
abstract: BACKGROUND
  Bloodstream infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these infections are needed.
  
  
  OBJECTIVE
  To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related infection, 2) patient tolerance of this catheter, and 3) the sources of bloodstream infection originating from noncuffed, multilumen central venous catheters.
  
  
  METHODS
  Randomized, controlled clinical trial.
  
  
  METHODS
  Medical-surgical intensive care unit of a 450-bed university hospital.
  
  
  METHODS
  158 adults scheduled to receive a central venous catheter; 403 catheters were studied.
  
  
  METHODS
  Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine.
  
  
  METHODS
  Catheters were studied for colonization and catheter-related bloodstream infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated bloodstream infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping.
  
  
  RESULTS
  Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce bloodstream infection (1.0 compared with 4.7 infections per 100 catheters; 1.6 compared with 7.6 infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related bloodstream infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no infections with these organisms occurred in the antiseptic catheter group (P = 0.003). No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 infections per 1000 catheter-days).
  
  
  CONCLUSIONS
  The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.
authors.affiliation: University of Wisconsin Hospital and Clinics-H4/574, Madison 53792, USA.
authors.forename: D G
authors.initials: DG
authors.lastname: Maki
authors.forename: S M
authors.initials: SM
authors.lastname: Stolz
authors.forename: S
authors.initials: S
authors.lastname: Wheeler
authors.forename: L A
authors.initials: LA
authors.lastname: Mermel
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000191:economics; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000191:economics / Q000382:microbiology; D002710:Chlorhexidine / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000517:prevention & control; D004269:DNA, Bacterial / Q000302:isolation & purification; D004279:DNA, Viral / Q000302:isolation & purification; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D018805:Sepsis / Q000191:economics / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D012837:Silver Sulfadiazine / Q000191:economics / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000891:Anti-Infective Agents, Local; D004269:DNA, Bacterial; D004279:DNA, Viral; D002710:Chlorhexidine; D012837:Silver Sulfadiazine