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Prevention of Central Venous Catheter-Related Bloodstream Infection by Use of an Antiseptic-Impregnated Catheter: A Randomized, Controlled Trial

Dennis G. Maki, MD; Susan M. Stolz, MS; Susan Wheeler, RN, MSN; and Leonard A. Mermel, DO, ScM
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From the University of Wisconsin Hospital and Clinics and University of Wisconsin-Madison, Madison, Wisconsin. Acknowledgments: The authors thank the physicians and nurses of the University of Wisconsin Center for Trauma and Life Support for their generous cooperation and permission to study patients with central venous catheters; research nurses Mary Meisch, Elizabeth Buckley, Mary Cullera, Josephine Krueger, and Yda Pack; Donald A. Berry, PhD, for statistical assistance; and Gail Maki, Peggy Barden, and Rachael Mikkelson for secretarial support. Grant Support: In part by a grant from Arrow International, Reading, Pennsylvania. None of the authors hold any personal financial interest in the new catheter studied in this trial or have served as consultants to Arrow International. Requests for Reprints: Dennis G. Maki, MD, University of Wisconsin Hospital and Clinics-H4/574, Madison, WI 53792. Current Author Addresses: Dr. Maki: University of Wisconsin Hospital and Clinics-H4/574, Madison, WI 53792.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(4):257-266. doi:10.7326/0003-4819-127-4-199708150-00001
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Background: Bloodstream infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these infections are needed.

Objective: To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related infection, 2) patient tolerance of this catheter, and 3) the sources of bloodstream infection originating from noncuffed, multilumen central venous catheters.

Design: Randomized, controlled clinical trial.

Setting: Medical-surgical intensive care unit of a 450-bed university hospital.

Participants: 158 adults scheduled to receive a central venous catheter; 403 catheters were studied.

Intervention: Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine.

Measurements: Catheters were studied for colonization and catheter-related bloodstream infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated bloodstream infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping.

Results: Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce bloodstream infection (1.0 compared with 4.7 infections per 100 catheters; 1.6 compared with 7.6 infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related bloodstream infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no infections with these organisms occurred in the antiseptic catheter group [P = 0.003]. No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 infections per 1000 catheter-days).

Conclusions: The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.

Figures

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Figure 1.
Kaplan-Meier estimate of the cumulative risk for catheter-related bloodstream infection.P

The differences between groups are highly significant ( = 0.01, log-rank test).

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Figure 2.
Pulsed-field electrophoresis of genomic DNA of isolates of Staphylococcus aureus from potential sources of infection with an infected catheter, subjected to Smal digestion.

The strains cultured from the proximal catheter segment and catheter tip and percutaneously drawn blood show restriction-fragment patterns identica to those in strains cultured from skip of the insertion site before disinfection and catheter insertion (Skin: Before) and at the time of catheter removal (Skin: Final). The strains differ from the unrelated control strain. Presumed pathocenesis of infection is from skin to catheter to blood.

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