title: Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care unit patients.
abstract: Central venous catheterization represents a significant medical advancement, particularly in the treatment of critical ill. However, there is a high risk of central venous catheters-related infection. A novel antiseptic central venous catheter, made of polyurethane and impregnated with chlorhexidine and silver sulfadiazine, was developed to reduce the risk of catheters-related infection. In this study, we did a randomized clinical study to determine the efficacy by using antiseptic catheters for the prevention of central venous catheters-related infection in the intensive care units. A total of 204 patients with 235 central venous catheters were studied at the surgical intensive care units at National Taiwan University Hospital between November 1998 and June 1999. Participants received either a standard triple-lumen polyurethane catheter or an antiseptic catheter (Arrow International, Reading, Pennsylvania, USA). Both were indistinguishable from each other. Compared to standard polyurethane catheters, antiseptic catheters were less likely to be colonized by microorganisms when they were cultured at the removal (8.0 versus 20.0 colonized catheters per 100 catheters; relative risk 0.34 [95% CI, 0.15 to 0.74]; p<0.01). There was no significant differences between both groups in catheter-related infections (0.9 versus 4.9 infections per 100 catheters; relative risk 0.17 [95% CI, 0.03 to 1.15]; p = 0.07). Gram-positive cocci and fungi were more likely to colonize in the standard polyurethane catheters (p = 0.06 and 0.04, compared to antiseptic catheters respectively). Two of our cases in the control group died directly due to catheter-related candidemia. No adverse reactions such as hypersensitivity or leukopenia were found in the antiseptic catheter group. Our study showed that central venous catheters with antiseptic coating were safe and had less risk of colonization of bacteria and fungi than standard catheters in the critically ill patients.
authors.affiliation: Department of Internal Medicine, Surgery and Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: W H
authors.initials: WH
authors.lastname: Sheng
authors.forename: W J
authors.initials: WJ
authors.lastname: Ko
authors.forename: J T
authors.initials: JT
authors.lastname: Wang
authors.forename: S C
authors.initials: SC
authors.lastname: Chang
authors.forename: P R
authors.initials: PR
authors.lastname: Hsueh
authors.forename: K T
authors.initials: KT
authors.lastname: Luh
mesh_terms: D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D002175:Candida / Q000302:isolation & purification; D002177:Candidiasis / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling / Q000009:adverse effects / Q000382:microbiology*; D002710:Chlorhexidine / Q000494:pharmacology*; D015169:Colony Count, Microbial; D003422:Critical Care / Q000379:methods; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000517:prevention & control; D016908:Gram-Positive Bacterial Infections / Q000517:prevention & control; D006095:Gram-Positive Cocci / Q000302:isolation & purification; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged; D011140:Polyurethanes; D012837:Silver Sulfadiazine / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D011140:Polyurethanes; D002710:Chlorhexidine; D012837:Silver Sulfadiazine