Observational trial of antibiotic-coated central venous catheters in critically ill pediatric patients.
BACKGROUND
Catheter-associated bloodstream infections (CABSI) are among the most common and serious adverse events experienced by critically ill children. Randomized trials have demonstrated that the use of central venous catheters (CVC) coated with antiseptic solutions reduces rates of CABSI in adult patients; however, their efficacy in children has not been evaluated.


OBJECTIVE
To compare the incidence of CABSI, rate of complications, and microbiology of infection in critically ill children treated with antibiotic-coated or noncoated CVC (NC-CVC).


METHODS
A prospective observational trial was conducted in the pediatric intensive care unit (PICU) during a 13-month period. A minocycline-rifampin-coated CVC (MR-CVC) or NC-CVC was placed by PICU physicians who nonpreferentially selected CVC type.


RESULTS
We studied the outcomes associated with the first CVC placed in 225 patients, including 69 MR-CVC and 156 NC-CVC. Patients who received MR-CVC, as compared with NC-CVC, were similar in gender, age, and severity of illness at time of PICU admission. The incidence density of CABSI did not vary by catheter type [MR-CVC: 7.53 per 1000 catheter-days (95% confidence interval 2.05-19.17); NC-CVC: 8.64 CABSI per 1000 catheter-days (95% confidence interval 3.74-16.96)]. However, the median time to infection in children with MR-CVC was 3-fold longer than in children with NC-CVC [18 versus 5 days (P = 0.053)]. No difference was seen in the incidence of complications, including thrombosis and catheter site reaction, between MR- and NC-CVC. No significant difference was observed in the types of organisms recovered from patients with MR- and NC-CVC.


CONCLUSIONS
The use of MR-CVC significantly delayed the onset of CABSI in PICU patients. Larger, randomized trials are needed to better define potential differences in the incidence of CABSI, rate of complications, and microbiology of infection among pediatric patients treated with antiseptic-coated CVC and NC-CVC.
Chelliah
Anjali
A
University of Pennsylvania School of Medicine, Department of Pediatrics, Philadelphia, PA 19104, USA.
Heydon
Kateri H
KH
Zaoutis
Theoklis E
TE
Rettig
Susan L
SL
Dominguez
Troy E
TE
Lin
Richard
R
Patil
Sujata
S
Feudtner
Chris
C
St John
Keith H
KH
Bell
Louis M
LM
Coffin
Susan E
SE
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000904:Antibiotics, Antitubercular / Q000008:administration & dosage*; D016470:Bacteremia / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D001769:Blood / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D008499:Medical Records; D008911:Minocycline / Q000008:administration & dosage*; D015143:Philadelphia / Q000453:epidemiology; D012293:Rifampin / Q000008:administration & dosage*; D016019:Survival Analysis; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000904:Antibiotics, Antitubercular; D008911:Minocycline; D012293:Rifampin