Antibiotic-impregnated catheters associated with significant decrease in nosocomial and multidrug-resistant bacteremias in critically ill patients.
OBJECTIVE
To evaluate the impact of using central venous catheters (CVCs) impregnated with the combination of minocycline and rifampin on nosocomial bloodstream infections (BSIs), morbidity, and mortality in cancer patients in the ICU.


METHODS
Prospective surveillance study consisting of the following two time periods: September 1997 through August 1998 (ie, fiscal year [FY] 1998); and from September 1998 through August 1999 (ie, FY 1999).


METHODS
ICUs of a tertiary care hospital in Houston, TX.


METHODS
Cancer patients in the medical ICU (MICU) and surgical ICU (SICU).


METHODS
ICUs started using CVCs impregnated with the minocycline-rifampin combination at the beginning of FY 1999.


RESULTS
The rates of nosocomial BSIs and other patients' characteristics were compared for the two study periods to determine the impact of using the impregnated catheters in the ICU. Patients' characteristics, including antibiotic use, were comparable for the two study periods in both the MICU and the SICU. The rate of nosocomial BSIs in the MICU unit decreased from 8.3 to 3.5 per 1,000 patient-days (p < 0.01), and decreased in the SICU from 4.8 to 1.3 per 1,000 patient-days (p < 0.01) in FY 1999. Nosocomial vancomycin-resistant enterococcus (VRE) bacteremia also decreased significantly (p = 0.004). Length of stay in the MICU and SICU significantly decreased in FY 1999 (p < 0.01 and p = 0.03, respectively). The duration of hospitalization decreased for MICU and SICU patients (p = 0.06 and p < 0.01, respectively). The rate of catheter-related infections decreased from 3.1 to 0.7 per 1,000 patient-days in FY 1999 (p = 0.02). The decrease in infections resulted in net savings of at least $1,450,000 for FY 1999.


CONCLUSIONS
The use of antibiotic-impregnated CVCs in the MICU and SICU was associated with a significant decrease in nosocomial BSIs, including VRE bacteremia, catheter-related infections, and lengths of hospital and ICU stays.
Hanna
Hend A
HA
Department of Infectious Diseases, Infection Control, and Employee Health (Unit 402), The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA. hhanna@mdanderson.org
Raad
Issam I
II
Hackett
Brenda
B
Wallace
Susannah K
SK
Price
Kristen J
KJ
Coyle
D Elizabeth
DE
Parmley
C Lee
CL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D020099:Coated Materials, Biocompatible; D003422:Critical Care; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control*; D018432:Drug Resistance, Multiple; D004359:Drug Therapy, Combination; D016983:Enterococcus / Q000187:drug effects; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline; D009369:Neoplasms / Q000401:mortality; D009894:Opportunistic Infections / Q000382:microbiology / Q000401:mortality / Q000517:prevention & control; D011446:Prospective Studies; D012293:Rifampin; D015996:Survival Rate; D013781:Texas; D020713:Vancomycin Resistance
D020099:Coated Materials, Biocompatible; D008911:Minocycline; D012293:Rifampin