title: Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients.
abstract: OBJECTIVE
  To compare the incidence of catheter colonization and catheter-related bloodstream infections between heparin-coated catheters and those coated with a synergistic combination of chlorhexidine and silver sulfadiazine.
  
  
  METHODS
  Randomized, controlled clinical trial.
  
  
  METHODS
  A 20-bed medical-surgical intensive care unit.
  
  
  METHODS
  A total of 180 patients requiring the insertion of a trilumen central venous catheter. INTERVENTIONS. Patients were randomized to receive either a trilumen heparin or chlorhexidine and silver sulfadiazine-coated catheter.
  
  
  METHODS
  Catheter colonization was defined by a semiquantitative catheter tip culture yielding 15 or more colony-forming units or quantitative culture of 1,000 or more colony-forming units/ml. Catheter-related bloodstream infection as the isolation of the same microorganism from a peripheral blood culture and catheter tip.
  
  
  RESULTS
  A total of 260 catheters were cultured. Out of 132 heparin-coated catheters, 29 were colonized and out of 128 chlorhexidine and silver sulfadiazine-coated catheters, 13 were colonized ( p=0.03), relative risk RR=2.16 (1.18-3.97). This represents an incidence of 23.5 and 11.5 episodes of catheter colonization per 1,000 catheter-days, respectively ( p=0.0059), RR=2.04 (1.05-3.84). Microorganisms isolated in catheter colonization from heparin-coated catheters were gram-positive cocci 23, gram-negative bacilli 7, and Candida spp 4. In chlorhexidine and silver sulfadiazine-coated catheters were gram-positive cocci 6 and gram-negative bacilli 11 ( p=0.009). The incidence of catheter-related bloodstream infections per 1,000 catheter-days was 3.24 in heparin-coated catheters and 2.6 in chlorhexidine and silver sulfadiazine-coated catheters ( p=0.79), RR=1.22 (0.27-5.43).
  
  
  CONCLUSIONS
  In critically ill patients the use of trilumen central venous catheters coated with chlorhexidine and silver sulfadiazine reduced the risk of catheter colonization due to prevention of gram-positive cocci and Candida spp.
authors.affiliation: Intensive Care Unit, Hospital Universitario de la Princesa, Diego de León 62, 28006 Madrid, Spain. ncarrasco.hlpr@salud.madrid.org
authors.forename: M N
authors.initials: MN
authors.lastname: Carrasco
authors.forename: A
authors.initials: A
authors.lastname: Bueno
authors.forename: C
authors.initials: C
authors.lastname: de las Cuevas
authors.forename: S
authors.initials: S
authors.lastname: Jimenez
authors.forename: I
authors.initials: I
authors.lastname: Salinas
authors.forename: A
authors.initials: A
authors.lastname: Sartorius
authors.forename: T
authors.initials: T
authors.lastname: Recio
authors.forename: M
authors.initials: M
authors.lastname: Generelo
authors.forename: F
authors.initials: F
authors.lastname: Ruiz-Ocaña
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000494:pharmacology*; D000925:Anticoagulants / Q000494:pharmacology; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000379:methods*; D002710:Chlorhexidine / Q000494:pharmacology*; D015169:Colony Count, Microbial; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012837:Silver Sulfadiazine / Q000494:pharmacology*; D013203:Staphylococcal Infections / Q000097:blood / Q000209:etiology / Q000382:microbiology; D013210:Staphylococcus / Q000187:drug effects / Q000302:isolation & purification
chemical_list: D000891:Anti-Infective Agents, Local; D000925:Anticoagulants; D006493:Heparin; D002710:Chlorhexidine; D012837:Silver Sulfadiazine