A comparison of two antimicrobial-impregnated central venous catheters. Catheter Study Group.
BACKGROUND
The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective catheters.


METHODS
We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the catheters were cultured by both the roll-plate and the sonication methods. Peripheral-blood cultures were obtained if clinically indicated.


RESULTS
Of 865 catheters inserted, 738 (85 percent) produced culture results that could be evaluated. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters impregnated with minocycline and rifampin were 1/3 as likely to be colonized as catheters impregnated with chlorhexidine and silver sulfadiazine (28 of 356 catheters [7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), and catheter-related bloodstream infection was 1/12 as likely in catheters impregnated with minocycline and rifampin (1 of 356 [0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnated with chlorhexidine and silver sulfadiazine; P<0.002).


CONCLUSIONS
The use of central venous catheters impregnated with minocycline and rifampin is associated with a lower rate of infection than the use of catheters impregnated with chlorhexidine and silver sulfadiazine.
Darouiche
R O
RO
Department of Medicine, Baylor College of Medicine and Veterans Affairs Medical Center, Houston, TX 77030, USA. Darouiche.Rabih.O@Houston.VA.Gov
Raad
I I
II
Heard
S O
SO
Thornby
J I
JI
Wenker
O C
OC
Gabrielli
A
A
Berg
J
J
Khardori
N
N
Hanna
H
H
Hachem
R
R
Harris
R L
RL
Mayhall
G
G
D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D001419:Bacteria / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002710:Chlorhexidine / Q000008:administration & dosage; D016172:DNA Fingerprinting; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage; D012307:Risk Factors; D012837:Silver Sulfadiazine / Q000008:administration & dosage
D000900:Anti-Bacterial Agents; D000891:Anti-Infective Agents, Local; D008911:Minocycline; D002710:Chlorhexidine; D012293:Rifampin; D012837:Silver Sulfadiazine