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Central Venous Catheters Coated with Minocycline and Rifampin for the Prevention of Catheter-Related Colonization and Bloodstream Infections: A Randomized, Double-Blind Trial

Issam Raad, MD; Rabih Darouiche, MD; Jacques Dupuis, MD; Dima Abi-Said, PhD; Andrea Gabrielli, MD; Ray Hachem, MD; Matthew Wall, MD; Richard Harris, MD; James Jones, MD; Antonio Buzaid, MD; Claudia Robertson, MD; Salwa Shenaq, MD; Patrick Curling, MD; Thomas Burke, MD; and Charles Ericsson, MD
[+] Article and Author Information

The Texas Medical Center Catheter Study Group From The University of Texas M.D. Anderson Cancer Center, Baylor College of Medicine Veterans Affairs Medical Center, Harris County Hospital District (Ben Taub General Hospital), The Methodist Hospital, and The University of Texas Health Science Center, Houston, Texas. *For members of the Texas Medical Center Catheter Study Group, see Appendix. Disclosure: Two patents are associated with the coated central venous catheter used in the study (catheters coated with minocycline and rifampin). The first patent, which describes the method of coating through the use of the cationic surfactant, is the property of the Robert Wood Johnson School of Medicine and Dentistry. Richard Harvey and Ralph Greco are the inventors. The second patent describes the synergistic and unique activity of the minocycline and rifampin combination in protecting catheter surfaces from slime-producing staphylococcal organisms. This patent is the property of The University of Texas M.D. Anderson Cancer Center and Baylor College of Medicine. Issam Raad and Rabih Darouiche (the first two authors of this article) are the inventors. Both patents were licensed by Cook Critical Care, with royalty rights to the Robert Wood Johnson School of Medicine and Dentistry, M.D. Anderson Cancer Center, and Baylor College of Medicine. The inventors receive a percentage of the royalties according to the royalty policies of each institution. None of the inventing senior authors have current links (such as stock ownership and service on a board or as a consultant) with Cook Critical Care or any other catheter company that might constitute a conflict of interest. Grant Support: In part by a grant from The University Cancer Foundation, The University of Texas M.D. Anderson Cancer Center, Houston, Texas. Catheters were supplied at no charge by Cook Critical Care, Bloomington, Indiana. Requests for Reprints: Issam Raad, MD, Section of Infection Control, Box 47, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. Current Author Addresses: Drs. Raad, Dupuis, Abi-Said, Hachem, Buzaid, and Burke: The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030. Drs. Darouiche and Jones: Veterans Affairs Medical Center, 2002 Holcombe Boulevard, Houston, TX 77030.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;127(4):267-274. doi:10.7326/0003-4819-127-4-199708150-00002
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Background: Central venous catheters are a principal source of nosocomial bloodstream infections, which are difficult to control.

Objective: To determine the efficacy of catheters coated with minocycline and rifampin in preventing catheter-related colonization and bloodstream infections.

Design: Multicenter, randomized clinical trial.

Setting: Five university-based medical centers.

Patients: 281 hospitalized patients who required 298 triple-lumen, polyurethane venous catheters.

Intervention: 147 catheters were pretreated with tridodecylmethyl-ammonium chloride and coated with minocycline and rifampin. Untreated, uncoated catheters (n = 151) were used as controls.

Measurements: Quantitative catheter cultures, blood cultures, and molecular typing of organisms to determine catheter-related colonization and bloodstream infections.

Results: The group with coated catheters and the group with uncoated catheters were similar with respect to age, sex, underlying diseases, degree of immunosuppression, therapeutic interventions, and risk factors for catheter infections. Colonization occurred in 36 (26%) uncoated catheters and 11 (8%) coated catheters (P < 0.001). Catheter-related bloodstream infection developed in 7 patients (5%) with uncoated catheters and no patients with coated catheters (P < 0.01). Multivariate logistic regression analysis showed that coating catheters with minocycline and rifampin was an independent protective factor against catheter-related colonization (P < 0.05). No adverse effects related to the coated catheters or antimicrobial resistance were seen. An estimate showed that the use of coated catheters could save costs.

Conclusions: Central venous catheters coated with minocycline and rifampin can significantly reduce the risk for catheter-related colonization and bloodstream infections. The use of these catheters may save costs.

Figures

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Figure 1.
Pulsed-field gel electrophoresis of seven pairs of organisms isolated from catheter and corresponding blood samples.EnterococcusStaphylococcus epidermidis

Lane M, DNA marker; lane N, negative control; lanes 1 and 2, feacalis; lanes 3 to 14, . Only five of seven pairs of strains (1 and 2, 3 and 4, 5 and 6, 7 and 8, 11 and 12) had similar DNA patterns. The other two pairs were isolated from two patients who met all of the definition criteria for catheter-related bloodstream infection except for identical molecular typing by pulsed-field gel electrophoresis.

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Figure 2.
Time to occurrence of catheter-related bloodstream infection according to study group.dashed lineP

The difference between coated ( ) and uncoated catheters (solid line) was significant ( < 0.01, exact log-rank test). The numbers of catheters at risk in each group at various time points are indicated on the abscissa.

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