Efficiency of chlorhexidine-silver sulfadiazine-impregnated venous catheters at subclavian sites.
BACKGROUND
Cost-effectiveness analyses show that chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters reduce catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, no studies have reported the efficiency of CHSS-impregnated catheters for venous access when the risk of CRBSI is low; for example, at the subclavian site. This study determined the cost of a CVC, diagnosis of CRBSI, and antimicrobial agents to treat CRBSI; we did not consider the cost of increased hospital stay.


METHODS
This retrospective study included patients admitted to the intensive care unit at Hospital Universitario de Canarias (Tenerife, Spain) who had a subclavian venous catheter.


RESULTS
Patients with CHSS catheters (n = 353) had a lower incidence density of CRBSI (2.12 vs 0 out of 1,000 catheter-days; P = .02) and lower CVC-related cost per catheter-day (3.35 ± 3.75 vs 3.94 ± 9.95; P = .002) than those with standard catheters (n = 518). CHSS-impregnated catheters were associated with a lower risk of CRBSI (exact logistic regression) (odds ratio, 0.10; 95% confidence interval, -∞ to 0.667; P = .008) than standard catheters when controlling for catheter duration. CHSS-impregnated catheters were also associated with a lower CVC-related cost per catheter day than standard catheters (Poisson regression) (odds ratio, 0.85; 95% confidence interval, 0.001-0.873; P < .001).


CONCLUSIONS
CHSS-impregnated catheters may be efficient in preventing CRBSI in patients with subclavian venous access.
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com.
Leonardo
L
Lorente
Department of Microbiology and Infection Control, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
María
M
Lecuona
Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Alejandro
A
Jiménez
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Lisset
L
Lorenzo
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Ruth
R
Santacreu
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Silvia
S
Ramos
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Eva
E
Hurtado
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
Manuel
M
Buitrago
Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
María L
ML
Mora
D000328:Adult; D000368:Aged; D055499:Catheter-Related Infections / Q000175:diagnosis / Q000191:economics / Q000517:prevention & control*; D002405:Catheterization, Central Venous / Q000379:methods*; D062905:Central Venous Catheters / Q000191:economics / Q000382:microbiology*; D002710:Chlorhexidine / Q000494:pharmacology*; D003365:Costs and Cost Analysis; D004202:Disinfectants / Q000494:pharmacology*; D004203:Disinfection / Q000191:economics / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012837:Silver Sulfadiazine / Q000494:pharmacology*; D013030:Spain; D013350:Subclavian Vein
D004202:Disinfectants; D002710:Chlorhexidine; D012837:Silver Sulfadiazine
Bacteremia; Central venous catheter