Benefits of minocycline and rifampin-impregnated central venous catheters. A prospective, randomized, double-blind, controlled, multicenter trial.
OBJECTIVE
To determine the efficacy of minocycline and rifampin-impregnated catheters compared to non-impregnated catheters in critically ill patients.


METHODS
Prospective, randomized, double-blind, controlled, multicenter trial.


METHODS
Intensive care units of seven acute-care teaching hospitals in Spain. PATIENTS. Intensive care unit patients requiring triple-lumen central venous catheter for more than 3 days.


METHODS
At catheter insertion, 228 patients were randomized to minocycline and rifampin-impregnated catheters and 237 to non-impregnated catheters. Skin, catheter tip, subcutaneous segment, hub cultures, peripheral blood and infusate cultures were performed at catheter withdrawal. The rate of colonization, catheter-related bloodstream infection (CRBSI) and catheter-related clinical infectious complications (purulence at the insertion site or CRBSI) were assessed.


RESULTS
In the intention-to-treat analysis (primary analysis), the episodes per 1000 catheter days of clinical infectious complications decreased from 8.6 to 5.7 (RR =0.67, 95% CI 0.31-1.44), CRBSI from 5.9 to 3.1 (RR =0.53, 95% CI 0.2-1.44) and tip colonization from 24 to 10.4 (RR =0.43, 95% CI 0.26-0.73). Antimicrobial-impregnated catheters were associated with a significant decrease of coagulase-negative staphylococci colonization (RR =0.24, 95% CI 0.13-0.45) and a significant increase of Candida spp. colonization (RR =5.84, 95% CI 1.31-26.1).


CONCLUSIONS
The use of antimicrobial-impregnated catheters was associated with a significantly lower rate of coagulase-negative staphylococci colonization and a significant increase in Candida spp. colonization, although a decrease in CRBSI, increase in 30-day survival or reduced length of stay was not observed.
Intensive Care Unit, Hospital Universitario de Valme, Universidad de Sevilla, Carretera de Cádiz s/n, 41014 Sevilla, Spain. cleong@infonegocio.com
Cristóbal
C
León
Sergio
S
Ruiz-Santana
Jordi
J
Rello
Maria V
MV
de la Torre
Jordi
J
Vallés
Francisco
F
Alvarez-Lerma
Rafael
R
Sierra
Pedro
P
Saavedra
Francisco
F
Alvarez-Salgado
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D017848:Blood-Borne Pathogens; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000382:microbiology; D016638:Critical Illness; D003428:Cross Infection / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004311:Double-Blind Method; D016503:Drug Delivery Systems; D006801:Humans; D007362:Intensive Care Units; D008911:Minocycline / Q000008:administration & dosage*; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage*; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D008911:Minocycline; D012293:Rifampin