title: Chlorhexidine-silver sulfadiazine-impregnated venous catheters are efficient even at subclavian sites without tracheostomy.
abstract: Chlorhexidine-silver sulfadiazine (CHSS)-impregnated catheters have been found to decrease the risk of catheter-related bloodstream infection (CRBSI) and central venous catheter (CVC)-related costs. However, there are no published data about cost-effectiveness of the use of CHSS-impregnated catheters in subclavian venous access without the presence of tracheostomy (thus, with a very low risk of CRBSI). That was the objective of this study.
  
  
  
  This was a retrospective study of patients admitted to a mixed intensive care unit who underwent placement of subclavian venous catheters without the presence of tracheostomy.
  
  
  
  Patients with standard catheters (n = 747) showed a higher CRBSI incidence density (0.95 vs 0/1,000 catheter-days; P = .02) and higher CVC-related cost per day ($3.78 ± $7.43 vs $3.31 ± $2.72; P < .001) than patients with a CHSS-impregnated catheter (n = 879). Exact logistic regression analysis showed that catheter duration (P = .02) and the type of catheter used (P = .01) were associated with the risk of CRBSI. Kaplan-Meier method showed that CHSS-impregnated catheters were associated with more prolonged CRBSI-free time than standard catheters (log-rank = 9.76; P = .002). Poisson regression analysis showed that CHSS-impregnated catheters were associated with a lower central venous catheter-related cost per day than standard catheters (odds ratio, 0.87; 95% confidence interval, 0.001-0.903; P < .001).
  
  
  
  The use of CHSS-impregnated catheters is an effective and efficient measure for the prevention of CRBSI even at subclavian venous access sites without the presence of tracheostomy.
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. Electronic address: lorentemartin@msn.com.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lorente
authors.affiliation: Department of Microbiology and Infection Control, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Lecuona
authors.affiliation: Research Unit, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Jiménez
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Cabrera
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Ruth
authors.initials: R
authors.lastname: Santacreu
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Lisset
authors.initials: L
authors.lastname: Lorenzo
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Raja
authors.affiliation: Department of Critical Care, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
authors.forename: María L
authors.initials: ML
authors.lastname: Mora
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000191:economics / Q000494:pharmacology*; D016470:Bacteremia / Q000191:economics / Q000517:prevention & control*; D055499:Catheter-Related Infections / Q000191:economics / Q000517:prevention & control; D002405:Catheterization, Central Venous / Q000191:economics / Q000379:methods*; D057785:Catheters / Q000191:economics*; D002710:Chlorhexidine / Q000191:economics / Q000494:pharmacology*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D017053:Infection Control / Q000191:economics / Q000379:methods*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012837:Silver Sulfadiazine / Q000191:economics / Q000494:pharmacology*
chemical_list: D000891:Anti-Infective Agents, Local; D002710:Chlorhexidine; D012837:Silver Sulfadiazine
keywords: Bacteremia; Central venous catheter