title: Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study.
abstract: OBJECTIVE
  To evaluate silver-impregnated (Oligon) central venous catheters and chlorhexidine-gluconate-impregnated sponges for reducing catheter-related colonization and infection, nonbacteremic or bacteremic.
  
  
  METHODS
  Multicenter, prospective, randomized, controlled study.
  
  
  METHODS
  Five general intensive care units in Greece.
  
  
  METHODS
  Intensive care unit patients requiring a multilumen central venous catheter between June 2006 and May 2008.
  
  
  METHODS
  Patients were randomly assigned to receive a standard catheter (standard group), a standard catheter plus chlorhexidine-gluconate-impregnated sponge (chlorhexidine-gluconate-impregnated sponge group), or an Oligon catheter (Oligon group). Catheter colonization was defined as a positive quantitative tip culture (≥10 colony-forming units/mL), catheter-related infection was defined by the previous criterion plus clinical evidence of sepsis, and bacteremia catheter-related infection as catheter-related infection plus a positive peripheral blood culture with the same micro-organism as in the catheter tip.
  
  
  RESULTS
  Data were obtained from 465 patients, 156 in the standard-group, 150 in the chlorhexidine-gluconate-impregnated sponge group, and 159 in the Oligon-group. Colonization occurred in 24 (15.4%) standard catheters, 21 (14%) in the chlorhexidine-gluconate-impregnated sponge group, and 25 (15.7%) in the Oligon catheters (p = .35) (20.9, 19.9, 21.8/1000 catheter-days, respectively). Catheter-related infections were recorded in nine (5.8%) standard catheters, six (4%) in the chlorhexidine-gluconate-impregnated sponge group, and seven (4.4%) in the Oligon catheters (p = .58) (7.8/1,000, 5.7/1,000, 6.1/1,000 catheter-days, respectively). No difference was observed between the chlorhexidine- gluconate-impregnated sponge group and the standard group regarding catheter colonization (hazard ratio 1.21; 95% confidence interval 0.56-2.61; p = .64) and catheter-related infections (hazard ratio 0.65; 95% confidence interval 0.23-1.85; p = .42). The Oligon catheter did not reduce colonization or catheter-related infections when compared with the standard catheter (colonization: hazard ratio 1.0; 95% confidence interval 0.46-2.21; p = .98; catheter-related infection: hazard ratio 0.72; 95% confidence interval 0.27-1.95; p = .52). Seven patients (1.5%, 2.09/1,000 catheter-days) presented bacteremic catheter-related infections. Central venous catheters inserted either in the internal jugular or the femoral vein had greater risk to be colonized than catheters inserted in the subclavian vein (internal jugular vs. subclavian: hazard ratio 3.29; 95% confidence interval 1.26-8.61; p = .01; femoral vs. subclavian: hazard ratio 3.36; 95% confidence interval 1.17-9.65; p = .02). Acinetobacter baumannii was the predominant pathogen (37.1% episodes of colonization, 36.4% catheter-related infections, 57.1% bacteremic catheter-related infections).
  
  
  CONCLUSIONS
  For short-term (median duration 7 days) central venous catheters in intensive care units with high prevalence of multiresistant Gram-negative bacteria, chlorhexidine-impregnated sponges and Oligon catheters as single preventive measures did not reduce catheter colonization or catheter-related infections. As a result of the limited amount of events, no conclusion could be reached regarding bacteremic catheter-related infections. The femoral site was the most frequently colonized insertion site in all types of catheters.
authors.affiliation: Intensive Care Unit, Papageorgiou General Hospital, Thessaloniki, Greece. arvanitik@hotmail.com
authors.forename: Kostoula
authors.initials: K
authors.lastname: Arvaniti
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Lathyris
authors.forename: Phyllis
authors.initials: P
authors.lastname: Clouva-Molyvdas
authors.forename: Anna-Bettina
authors.initials: AB
authors.lastname: Haidich
authors.forename: Eleni
authors.initials: E
authors.lastname: Mouloudi
authors.forename: Eleni
authors.initials: E
authors.lastname: Synnefaki
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Koulourida
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Georgopoulos
authors.forename: Nikoleta
authors.initials: N
authors.lastname: Gerogianni
authors.forename: Georgios
authors.initials: G
authors.lastname: Nakos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Matamis
mesh_terms: D000704:Analysis of Variance; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002408:Catheters, Indwelling / Q000382:microbiology*; D002710:Chlorhexidine / Q000494:pharmacology*; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D004202:Disinfectants / Q000494:pharmacology; D004866:Equipment Contamination / Q000517:prevention & control; D004867:Equipment Design; D005260:Female; D006115:Greece; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011446:Prospective Studies; D011786:Quality Control; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D013234:Stem Cells; D015503:Surgical Sponges
chemical_list: D004202:Disinfectants; D002710:Chlorhexidine