title: Comparison of antimicrobial impregnation with tunneling of long-term central venous catheters: a randomized controlled trial.
abstract: OBJECTIVE
  We sought to compare the impact of antimicrobial impregnation to that of tunneling of long-term central venous catheters on the rates of catheter colonization and catheter-related bloodstream infection.
  
  
  BACKGROUND
  Tunneling of catheters constitutes a standard of care for preventing infections associated with long-term vascular access. Although antimicrobial coating of short-term central venous catheters has been demonstrated to protect against catheter-related bloodstream infection, the applicability of this preventive approach to long-term vascular access has not been established.
  
  
  METHODS
  A prospective, randomized clinical trial in 7 university-affiliated hospitals of adult patients who required a vascular access for > or = 2 weeks. Patients were randomized to receive a silicone central venous catheter that was either impregnated with minocycline and rifampin or tunneled. The occurrence of catheter colonization and catheter-related bloodstream infection was determined.
  
  
  RESULTS
  Of a total of 351 inserted catheters, 346 (186 antimicrobial-impregnated and 160 tunneled) were analyzed for catheter-related bloodstream infection. Clinical characteristics were comparable in the 2 study groups, but the antimicrobial-impregnated catheters remained in place for a shorter period of time (mean, 30.2 versus 43.8 days). Antimicrobial-impregnated catheters were as likely to be colonized as tunneled catheters (7.9 versus 6.3 per 1000 catheter-days). Bloodstream infection was 4 times less likely to originate from antimicrobial-impregnated than from tunneled catheters (0.36 versus 1.43 per 1000 catheter-days).
  
  
  CONCLUSIONS
  Antimicrobial impregnation of long-term central venous catheters may help obviate the need for tunneling of catheters.
authors.affiliation: Center for Prostheses Infection, Baylor College of Medicine, Houston, Texas 77030, USA. rdarouiche@aol.com
authors.forename: Rabih O
authors.initials: RO
authors.lastname: Darouiche
authors.forename: David H
authors.initials: DH
authors.lastname: Berger
authors.forename: Nancy
authors.initials: N
authors.lastname: Khardori
authors.forename: Claudia S
authors.initials: CS
authors.lastname: Robertson
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Wall
authors.forename: Michael H
authors.initials: MH
authors.lastname: Metzler
authors.forename: Seema
authors.initials: S
authors.lastname: Shah
authors.forename: Mohammad D
authors.initials: MD
authors.lastname: Mansouri
authors.forename: Colleen
authors.initials: C
authors.lastname: Cerra-Stewart
authors.forename: James
authors.initials: J
authors.lastname: Versalovic
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Reardon
authors.forename: Issam I
authors.initials: II
authors.lastname: Raad
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage; D011446:Prospective Studies; D012293:Rifampin / Q000008:administration & dosage; D018805:Sepsis / Q000517:prevention & control*; D012828:Silicones
chemical_list: D000900:Anti-Bacterial Agents; D012828:Silicones; D008911:Minocycline; D012293:Rifampin