Prevention of intravascular catheter-related infection with newer chlorhexidine-silver sulfadiazine-coated catheters: a randomized controlled trial.
BACKGROUND
The indication of antiseptic-coated catheters remains debated.


OBJECTIVE
To test the ability of the new generation of chlorhexidine-silver and sulfadiazine-coated catheters, with enhanced antiseptic coating, to reduce the risk of central venous catheter (CVC)-related infection in ICU patients.


METHODS
Multicentre randomized double-blind trial.


METHODS
A total of 397 patients from 14 ICUs of university hospitals in France.


METHODS
Patients were randomized to receive an antiseptic-coated catheter (ACC) or a standard non-coated catheter (NCC).


METHODS
Incidence of CVC-related infection.


RESULTS
Of 367 patients having a successful catheter insertion, 363 were analysed (175 NCC and 188 ACC). Patients had one (NCC=162, ACC=180) or more (NCC=13, ACC=11) CVC inserted. The two groups were similar for insertion site [subclavian (64 vs 69)] or jugular (36 vs 31%)], and type of catheters (single-lumen 18 vs 18%; double-lumen 82 vs 82%), and mean (median) duration of catheterisation [12.0+/-11.7 (9) vs 10.5+/-8.8 (8) days in the NCC and ACC groups, respectively]. Significant colonisation of the catheter occurred in 23 (13.1%) and 7 (3.7%) patients, respectively, in the NCC and ACC groups (11 vs 3.6 per 1000 catheter-days; p=0.01); CVC-related infection (bloodstream infection) occurred in 10 (5) and 4 (3) patients in the NCC and CC groups, respectively (5.2 vs 2 per 1000 catheter days; p=0.10).


CONCLUSIONS
In the context of a low baseline infection rate, ACC were associated with a significant reduction of catheter colonisation and a trend to reduction of infection episodes, but not of bloodstream infection.
Brun-Buisson
Christian
C
Réanimation Médicale, Hôpital Henri Mondor (AP-HP), Av du Maréchal de Lattre de Tassigny, 94010 Créteil Cedex, France. christian.brun-buisson@hmn.ap-hop-paris.fr
Doyon
Françoise
F
Sollet
Jean-Pierre
JP
Cochard
Jean-François
JF
Cohen
Yves
Y
Nitenberg
Gérard
G
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002710:Chlorhexidine / Q000627:therapeutic use*; D004311:Double-Blind Method; D004866:Equipment Contamination / Q000517:prevention & control*; D005602:France; D006801:Humans; D007362:Intensive Care Units; D008875:Middle Aged; D012720:Severity of Illness Index; D012837:Silver Sulfadiazine / Q000627:therapeutic use*
D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D012837:Silver Sulfadiazine