A prospective, randomized trial of rifampicin-minocycline-coated and silver-platinum-carbon-impregnated central venous catheters.
OBJECTIVE
Central venous catheters are the predominant cause of nosocomial bacteremia; however, the effectiveness of different antimicrobial central venous catheters remains uncertain. We compared the infection rate of silver-platinum-carbon (SPC)-impregnated catheters with rifampicin-minocycline (RM)-coated catheters.


METHODS
A large, single-center, prospective randomized study.


METHODS
Twenty-two-bed adult general intensive care unit in a large tertiary metropolitan hospital in Brisbane, Australia (2000-2001).


METHODS
Consecutive series of all central venous catheterizations in intensive care unit patients.


METHODS
Randomization, concealment, and blinding were carefully performed. Catheter insertion and care were performed according to published guidelines. Blood cultures were taken at central venous catheter removal, and catheter-tip cultures were performed by both roll-plate and sonication techniques. Pulsed field gel electrophoresis was used to establish shared clonal origin for matched isolates.


RESULTS
Central venous catheter colonization and catheter-related bloodstream infection were determined with a blinded technique using the evaluation of the extensive microbiological and clinical data collected and a rigorous classification system. Six hundred forty-six central venous catheters (RM 319, SPC 327) were inserted, and 574 (89%) were microbiologically evaluable. Colonization rates were lower for the RM catheters than SPC catheters (25 of 280, 8.9%; 43 of 294, 14.6%; p=.039). A Kaplan-Meier analysis that included catheter time in situ did not quite achieve statistical significance (p=.055). Catheter-related bloodstream infection was infrequent for both catheter-types (RM 4, 1.4%; SPC 5, 1.7%).


CONCLUSIONS
The SPC catheter is a clinically effective antimicrobial catheter; however, the RM catheter had a lower colonization rate. Both catheter types had low rates of catheter-related bloodstream infection. These results indicate that future studies will require similar rigorous methodology and thousands of central venous catheters to demonstrate differences in catheter-related bloodstream infection rates.
Fraenkel
David
D
Department of Intensive Care, Princess Alexandra Hospital, and School of Population Health, University of Queensland, Australia.
Rickard
Claire
C
Thomas
Peter
P
Faoagali
Joan
J
George
Narelle
N
Ware
Robert
R
D000891:Anti-Infective Agents, Local / Q000627:therapeutic use*; D016470:Bacteremia / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002244:Carbon; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004866:Equipment Contamination / Q000517:prevention & control; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000627:therapeutic use*; D010984:Platinum; D011446:Prospective Studies; D011793:Queensland / Q000453:epidemiology; D012293:Rifampin / Q000627:therapeutic use*; D012834:Silver / Q000627:therapeutic use*
D000891:Anti-Infective Agents, Local; D012834:Silver; D010984:Platinum; D002244:Carbon; D008911:Minocycline; D012293:Rifampin