title: Central venous catheter colonization in critically ill patients: a prospective, randomized, controlled study comparing standard with two antiseptic-impregnated catheters.
abstract: In this prospective, randomized, controlled, unblinded study, we compared colonization rates of a standard, unimpregnated central venous catheter (CVC) with rates for silver-coated and chlorhexidine-silversulfadiazine (CH-SS)-impregnated CVC. Patient characteristics, CVC insertion site, indwelling time, and colonization detected by semiquantitative and quantitative microbiologic techniques were documented. Two-hundred-seventy-five critically ill patients were included into the study protocol. One-hundred-sixty standard, 160 silver (S)-coated, and 165 externally impregnated CH-SS CVC were inserted. There was a significant difference in CVC colonization rates among study groups (P = 0.029). There was no difference in the colonization rate and the colonization per 1000 catheter days between standard and S-coated (P = 0.564; P = 0.24) or CH-SS-coated CVC (P= 0.795; P = 0.639). When comparing antiseptic CVC with each other, colonization rates were significantly less with CH-SS-impregnated than with S-coated CVC (16.9% versus 7.3%; P = 0.01; 18.2 versus 7.5 of 1000 catheter days; P = 0.003; relative risk, 0.43; 95% confidence interval, 0.21-0.85). Whereas standard and S-coated CVC were first colonized 2 and 3 days after insertion, respectively, CH-SS CVC were first colonized only after 7 days. In conclusion, antiseptic-impregnated CVC could not prevent catheter colonization when compared with standard polyurethane catheters in a critical care setting with infrequent catheter colonization rates and CVC left in place for >10 days.
authors.affiliation: *Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, †Institute for Hospital Hygienics and Social Medicine, and ‡Institute for Medical Biostatistics, Innsbruck Medical University; §Department of Anesthesia and Critical Care Medicine, Krankenhaus der Barmherzigen Schwestern, Ried I. Innkreis, Austria.
authors.forename: Martin W
authors.initials: MW
authors.lastname: Dünser
authors.forename: Andreas J
authors.initials: AJ
authors.lastname: Mayr
authors.forename: Guido
authors.initials: G
authors.lastname: Hinterberger
authors.forename: Cornelia Lass
authors.initials: CL
authors.lastname: Flörl
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Stefan
authors.initials: S
authors.lastname: Schmid
authors.forename: Barbara
authors.initials: B
authors.lastname: Friesenecker
authors.forename: Ingo
authors.initials: I
authors.lastname: Lorenz
authors.forename: Walter R
authors.initials: WR
authors.lastname: Hasibeder
mesh_terms: D000328:Adult; D000368:Aged; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage*; D001424:Bacterial Infections / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002710:Chlorhexidine / Q000008:administration & dosage*; D016638:Critical Illness; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012837:Silver Sulfadiazine / Q000008:administration & dosage*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D012837:Silver Sulfadiazine