title: Effectiveness of Minocycline and Rifampin vs Chlorhexidine and Silver Sulfadiazine-Impregnated Central Venous Catheters in Preventing Central Line-Associated Bloodstream Infection in a High-Volume Academic Intensive Care Unit: A Before and after Trial.
abstract: BACKGROUND
  Use of chlorhexidine and silver sulfadiazine-impregnated (CSS) central venous catheters (CVCs) has not been shown to decrease the catheter-related bloodstream infection rate in an ICU. The purpose of this study was to determine if use of minocycline and rifampin-impregnated (MR) CVCs would decrease central line-associated bloodstream infection (CLABSI) rates compared with those observed with use of CSS-impregnated CVCs.
  
  
  METHODS
  A total of 7,181 patients were admitted to a 24-bed university hospital surgical ICU: 2,551 between March 2004 and August 2005 (period 1) and 4,630 between April 2006 and July 2008 (period 2). All patients requiring CVC placement in period 1 had a CSS catheter inserted, and in period 2 all patients had MR CVCs placed.
  
  
  RESULTS
  Twenty-two CLABSIs occurred during 7,732 catheter days (2.7 per 1,000 catheter days) in the 18-month period when CSS lines were used. After the introduction of MR CVCs, 21 catheter-related bloodstream infections occurred during 15,722 catheter days (1.4 per 1,000 catheter days). This represents a significant (p < 0.05) decrease in the CLABSI rate after introduction of MR CVCs. Mean length of time to infection developing after catheterization (8.6 days for CSS vs 6.1 days for MR) was also different (p = 0.04). The presence of MR did not alter the microbiologic profile of catheter-related infections, and it did not increase the incidence of resistant organisms.
  
  
  CONCLUSIONS
  The CLABSI rate decreased more with the use of MR CVCs compared with CSS CVCs in an ICU where the CLABSI rate was already low. The types of organisms causing infection were similar. With continued use of MR-impregnated CVCs in our ICU in the subsequent 5 years, we have seen sustained low rates of CLABSIs.
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO. Electronic address: bonnes@wudosis.wustl.edu.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Bonne
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: John E
authors.initials: JE
authors.lastname: Mazuski
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO.
authors.forename: Carie
authors.initials: C
authors.lastname: Sona
authors.affiliation: Barnes-Jewish Hospital, St Louis, MO.
authors.forename: Marilyn
authors.initials: M
authors.lastname: Schallom
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St Louis, MO.
authors.forename: Walter
authors.initials: W
authors.lastname: Boyle
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Buchman
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Grant V
authors.initials: GV
authors.lastname: Bochicchio
authors.affiliation: Department of Surgery, Emory University School of Medicine, Atlanta, GA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Coopersmith
authors.affiliation: Department of Surgery, Washington University School of Medicine, St Louis, MO.
authors.forename: Douglas J E
authors.initials: DJ
authors.lastname: Schuerer
mesh_terms: D000046:Academic Medical Centers; D000890:Anti-Infective Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000209:etiology / Q000517:prevention & control*; D062905:Central Venous Catheters / Q000009:adverse effects; D002710:Chlorhexidine / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage*; D012293:Rifampin / Q000008:administration & dosage*; D012837:Silver Sulfadiazine / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D008911:Minocycline; D002710:Chlorhexidine; D012293:Rifampin; D012837:Silver Sulfadiazine