The clinical and economic consequences of nosocomial central venous catheter-related infection: are antimicrobial catheters useful?
Central venous catheters (CVCs) are essential for many hospitalized patients, but they are associated with important infectious complications. Recent studies have indicated that CVCs coated with antimicrobial agents reduce the incidence of catheter-related bloodstream infection (CR BSI). To estimate the clinical and economic consequences of short-term central venous catheter-related infection and the potential usefulness of antimicrobial-coated catheters, we reviewed and synthesized the available relevant literature. Statistical pooling was used to estimate the incidence of both catheter colonization and CR BSI. The attributable mortality of CR BSI was also evaluated. In addition, the economic consequences of both local and systemic catheter-related infection was estimated from literature reports that used micro-costing and other techniques. Among patients in whom standard, noncoated CVCs are in place for an average of 8 days, 24.7% are expected to develop catheter colonization (95% confidence interval [CI(95)], 22.0%-27.5%). Approximately 5.2% (CI(95), 3.9%-6.5%) will develop CR BSI. The attributable mortality of CR BSI remains unclear, but recent studies are consistent with a range from 4% to 20%. An episode of local catheter-related infection leads to an additional cost of approximately $400, whereas the additional cost of CR BSI ranges from approximately $6,005 to $9,738. Formal economic analyses indicate that CVCs coated with antibacterial agents (such as chlorhexidine-silver sulfadiazine or minocycline-rifampin) likely reduce infectious complications, yielding economic advantages. In light of the substantial clinical and economic burden of catheter-related infection, hospital personnel should adopt proven cost-effective methods to reduce this common and important nosocomial complication.
Saint
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Department of Medicine, University of Michigan Medical School, Ann Arbor Veterans' Affairs Health Services Research and Development Service, USA.
Veenstra
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Lipsky
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D000890:Anti-Infective Agents / Q000627:therapeutic use*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D020099:Coated Materials, Biocompatible; D003362:Cost-Benefit Analysis; D003428:Cross Infection / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D018805:Sepsis / Q000191:economics / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*
D000890:Anti-Infective Agents; D020099:Coated Materials, Biocompatible