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Effect of a Second-Generation Venous Catheter Impregnated with Chlorhexidine and Silver Sulfadiazine on Central Catheter–Related Infections: A Randomized, Controlled Trial

Mark E. Rupp, MD; Steven J. Lisco, MD; Pamela A. Lipsett, MD; Trish M. Perl, MD, MSc; Kevin Keating, MD; Joseph M. Civetta, MD; Leonard A. Mermel, DO, ScM; David Lee, MD; E. Patchen Dellinger, MD; Michael Donahoe, MD; David Giles, MD; Michael A. Pfaller, MD; Dennis G. Maki, MD; and Robert Sherertz, MD
[+] Article, Author, and Disclosure Information

From the University of Nebraska Medical Center, Omaha, Nebraska; Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Johns Hopkins University School of Medicine, Baltimore, Maryland; Hartford Hospital, Hartford, and University of Connecticut, Farmington, Connecticut; Rhode Island Hospital and Brown Medical School, Providence, Rhode Island; Rochester General Hospital, Rochester, New York; University of Washington, Seattle, Washington; University of Pittsburgh, Pittsburgh, Pennsylvania; University of Iowa, Iowa City, Iowa; University of Wisconsin, Madison, Wisconsin; and Wake Forest University, Winston-Salem, North Carolina.

Note: This study was presented in abstract form (Abstract K-2047) at the 41st Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, Illinois, 16–19 December 2001.

Acknowledgments: The authors thank the numerous persons at each of the participating centers who assisted with the conduct of this trial, including study coordinators, clinical nurses, and laboratory personnel. They also thank Dr. Orlando Morejon for initiating the trial at the University of Connecticut Health Center; Shaan Schaeffer at Arrow International for logistic support; and Alison Nelson, Mindy Liss, Greg Maislin, and Michael Feldstein for the statistical analysis of data.

Grant Support: By Arrow International, Inc.

Potential Financial Conflicts of Interest: Consultancies: J.M. Civetta (Arrow International), L.A. Mermel (3M); Honoraria: M.E. Rupp (Arrow International), T.M. Perl (Edwards Life Science), L.A. Mermel (3M); Grants received: M.E. Rupp (Arrow International), S.J. Lisco (Arrow International), T.M. Perl (Arrow International), K. Keating (Arrow International), J.M. Civetta (Arrow International), L.A. Mermel (3M, Johnson & Johnson, Micrologix), D. Lee (Arrow International), E.P. Dellinger (Arrow International), M. Donahoe (Arrow International), D. Giles (Arrow International), M.A. Pfaller (Arrow International), R. Sherertz (Arrow International).

Requests for Single Reprints: Mark E. Rupp, MD, 984031 Nebraska Medical Center, Omaha, NE 68198-4031; e-mail, merupp@unmc.edu.

Current Author Addresses: Dr. Rupp: 984031 Nebraska Medical Center, Omaha, NE 68198-4031.

Dr. Lisco: 350 Engle Street, Englewood, NJ 07631.

Dr. Lipsett: 600 N. Wolfe Street, Blalock 685, Baltimore, MD 21287-4685.

Dr. Perl: 600 N. Wolfe Street, 425 Osler, Baltimore, MD 21287-4425.

Dr. Keating: 80 Seymore Street, Hartford, CT 06102.

Dr. Civetta: 263 Farmington Avenue, Farmington, CT 06030.

Dr. Mermel: 593 Eddy Street, Providence, RI 02903.

Dr. Lee: 1425 Portland Avenue, Rochester, NY 14621.

Dr. Dellinger: 1959 NE Pacific Street, Seattle, WA 98195-6410.

Dr. Donahoe: 625 NW Montefiore University Hospital, 3459 Fifth Avenue, Pittsburgh, PA 15213.

Dr. Giles: 263 Farmington Avenue, Farmington, CT 06030.

Dr. Pfaller: C606B General Hospital, 200 Hawkins Drive, Iowa City, IA 52242-1009.

Dr. Maki: 600 Highland Avenue, H4/574 Box 5158, Madison, WI 53792-5158.

Dr. Sherertz: Section of Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC 27157-1042.

Author Contributions: Conception and design: M.E. Rupp, S.J. Lisco, E.P. Dellinger, R. Sherertz.

Analysis and interpretation of the data: M.E. Rupp, T.M. Perl, J.M. Civetta, M.A. Pfaller, D.G. Maki.

Drafting of the article: M.E. Rupp, M. Donahoe, R. Sherertz.

Critical revision of the article for important intellectual content: M.E. Rupp, P.A. Lipsett, K. Keating, J.M. Civetta, L.A. Mermel, D. Lee, E.P. Dellinger, M. Donahoe, M.A. Pfaller, D.G. Maki, R. Sherertz.

Final approval of the article: M.E. Rupp, S.J. Lisco, P.A. Lipsett, T.M. Perl, K. Keating, J.M. Civetta, L.A. Mermel, D. Lee, E.P. Dellinger, M. Donahoe, D. Giles, M.A. Pfaller, D.G. Maki, R. Sherertz. Provision of study materials or patients: M.E. Rupp, S.J. Lisco, P.A. Lipsett, K. Keating, J.M. Civetta, L.A. Mermel, D. Lee, E.P. Dellinger, M. Donahoe, D. Giles. Statistical expertise: M.E. Rupp. Administrative, technical, or logistical support: T.M. Perl. Collection and assembly of data: M.E. Rupp, P.A. Lipsett, T.M. Perl, K. Keating, D. Lee, M.A. Pfaller.

Ann Intern Med. 2005;143(8):570-580. doi:10.7326/0003-4819-143-8-200510180-00007
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According to the Centers for Disease Control and Prevention (CDC), approximately 53% of adult patients in intensive care units have a central venous catheter on any given day (15). Central venous catheter–related infections are associated with significant mortality, morbidity, and excess cost, making them particularly worthy of preventive measures. The CDC has set a goal of decreasing catheter-associated adverse events by 50% as one of its top patient safety challenges (16). Previous studies indicate that approximately 50% of infections result from microbes gaining access to the catheters from the cutaneous surface, whereas the remaining 50% of infections result from contamination of the hub and infusate (910). Our study supports the premise that colonization of short-term, nontunneled catheters largely results from the patient's skin flora and initially involves the external surface of the catheter. Once organisms (mainly coagulase-negative staphylococci) gain access to the device, infection is derived from their ability to adhere, proliferate, and elaborate biofilm (1718). Therefore, to prevent infection, catheters have been modified to reduce microbial adherence and proliferation.

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Grahic Jump Location
Figure 1.
Distribution of initial study catheters by type and method of insertion.
Grahic Jump Location
Grahic Jump Location
Figure 2.
Kaplan–Meier curve demonstrating initial study catheters free of microbial colonization versus time.

Symbols indicate the point at which a catheter was censored. Chlorhexidine–silver sulfadiazine central venous catheters (CVCs) were substantially less likely to become colonized by microbes during their period of clinical use than the uncoated control catheters (P  ≤ 0.01, log-rank test). The percent of catheters free of colonization (and the standard error) at days 10, 20, and 30 for control and antiseptic-coated catheters, respectively, are as follows: day 10, 75.7% (3.6%) and 87.6% (3.0%); day 20, 51.5% (6.4%) and 58.8% (8.0%); and day 30, 27.5% (13.2%) and 58.8% (8.0%).

Grahic Jump Location




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Summary for Patients

Can Antibiotic-Coated Catheters Help Decrease the Incidence of Bloodstream Infections in Patients in the Intensive Care Unit?

The summary below is from the full report titled “Effect of a Second-Generation Venous Catheter Impregnated with Chlorhexidine and Silver Sulfadiazine on Central Catheter–Related Infections. A Randomized, Controlled Trial.” It is in the 18 October 2005 issue of Annals of Internal Medicine (volume 143, pages 570-580). The authors are M.E. Rupp, S.J. Lisco, P.A. Lipsett, T.M. Perl, K. Keating, J.M. Civetta, L.A. Mermel, D. Lee, E.P. Dellinger, M. Donahoe, D. Giles, M.A. Pfaller, D.G. Maki, and R. Sherertz.


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