title: Comparison of triple-lumen central venous catheters impregnated with silver nanoparticles (AgTive®) vs conventional catheters in intensive care unit patients.
abstract: BACKGROUND
  Silver-impregnated central venous catheters (CVCs) have been proposed as a means for preventing CVC colonization and related bloodstream infections (CRBSIs).
  
  
  OBJECTIVE
  To evaluate the efficacy of CVCs impregnated with silver nanoparticles in a large group of critically ill patients.
  
  
  METHODS
  A prospective, randomized clinical trial was conducted in five intensive care units (ICUs). Three hundred and thirty-eight adult patients requiring CVCs between April 2006 and November 2008 were randomized to receive AgTive silver-nanoparticle-impregnated (SC) or conventional (CC) CVCs. Primary endpoints were CVC colonization (growth of ≥15 colony-forming units from the catheter tip) and incident CRBSIs (meeting the definitions of the Centers for Disease Control and Prevention). Infection-free time (days from initial CVC insertion to initial blood culture positivity) and ICU mortality rates were measured as secondary endpoints.
  
  
  RESULTS
  The SC group (N = 135) and CC group (N = 137) were similar in terms of clinical and laboratory parameters at baseline, reasons for ICU admission, complications during CVC insertion, and total time with CVC (mean ± standard deviation; SC 13 ± 24 vs CC 15 ± 37 days). No significant intergroup differences were found in CVC colonization rates (SC 32.6% vs CC 30%; P = 0.7), CRBSI incidence rates (3.36 infections per 1000 catheter-days in both groups), infection-free times (SC 13 ± 34 vs CC 12 ± 12 days; P = 0.85) or ICU mortality (SC 46% vs CC 43%; P = 0.7).
  
  
  CONCLUSIONS
  In critically ill patients, use of AgTive(®) silver-nanoparticle-impregnated CVCs had no significant effect on CVC colonization, CRBSI incidence or ICU mortality. These CVCs cannot be recommended as an adjunctive tool for control of CRBSIs.
authors.affiliation: Department of Intensive Care and Anaesthesiology, Università Cattolica del Sacro Cuore, Rome, Italy. m.antonelli@rm.unicatt.it
authors.forename: M
authors.initials: M
authors.lastname: Antonelli
authors.forename: G
authors.initials: G
authors.lastname: De Pascale
authors.forename: V M
authors.initials: VM
authors.lastname: Ranieri
authors.forename: P
authors.initials: P
authors.lastname: Pelaia
authors.forename: R
authors.initials: R
authors.lastname: Tufano
authors.forename: O
authors.initials: O
authors.lastname: Piazza
authors.forename: A
authors.initials: A
authors.lastname: Zangrillo
authors.forename: A
authors.initials: A
authors.lastname: Ferrario
authors.forename: A
authors.initials: A
authors.lastname: De Gaetano
authors.forename: E
authors.initials: E
authors.lastname: Guaglianone
authors.forename: G
authors.initials: G
authors.lastname: Donelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000494:pharmacology*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000009:adverse effects* / Q000382:microbiology; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D053758:Nanoparticles; D011446:Prospective Studies; D012834:Silver / Q000494:pharmacology*; D016019:Survival Analysis
chemical_list: D000890:Anti-Infective Agents; D012834:Silver