A Comparison of Two Antimicrobial-Impregnated Central Venous Catheters
Rabih O. Darouiche, M.D., Issam I. Raad, M.D., Stephen O. Heard, M.D., John I. Thornby, Ph.D., Olivier C. Wenker, M.D., Andrea Gabrielli, M.D., Johannes Berg, M.D., Nancy Khardori, M.D., Hend Hanna, M.D., Ray Hachem, M.D., Richard L. Harris, M.D., Glen Mayhall, M.D., for The Catheter Study Group
Background The use of central venous catheters impregnated witheither minocycline and rifampin or chlorhexidine and silversulfadiazine reduces the rates of catheter colonization andcatheter-related bloodstream infection as compared with theuse of unimpregnated catheters. We compared the rates of cathetercolonization and catheter-related bloodstream infection associatedwith these two kinds of antiinfective catheters.
Methods We conducted a prospective, randomized clinical trialin 12 university-affiliated hospitals. High-risk adult patientsin whom central venous catheters were expected to remain inplace for three or more days were randomly assigned to undergoinsertion of polyurethane, triple-lumen catheters impregnatedwith either minocycline and rifampin (on both the luminal andexternal surfaces) or chlorhexidine and silver sulfadiazine(on only the external surface). After their removal, the tipsand subcutaneous segments of the catheters were cultured byboth the roll-plate and the sonication methods. Peripheral-bloodcultures were obtained if clinically indicated.
Results Of 865 catheters inserted, 738 (85 percent) producedculture results that could be evaluated. The clinical characteristicsof the patients and the risk factors for infection were similarin the two groups. Catheters impregnated with minocycline andrifampin were 1/3 as likely to be colonized as catheters impregnatedwith chlorhexidine and silver sulfadiazine (28 of 356 catheters[7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), andcatheter-related bloodstream infection was 1/12 as likely incatheters impregnated with minocycline and rifampin (1 of 356[0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnatedwith chlorhexidine and silver sulfadiazine; P<0.002).
Conclusions The use of central venous catheters impregnatedwith minocycline and rifampin is associated with a lower rateof infection than the use of catheters impregnated with chlorhexidineand silver sulfadiazine.
Source Information
From the Departments of Medicine (R.O.D., R.L.H.), Physical Medicine and Rehabilitation (R.O.D.), Family and Community Medicine (J.I.T.), and Anesthesiology (O.C.W.), Baylor College of Medicine and Veterans Affairs Medical Center, Houston; the Department of Medical Subspecialties, University of Texas M.D. Anderson Cancer Center, Houston (I.I.R., H.H., R.H.); the Department of Anesthesiology, University of Massachusetts Medical Center, Worcester (S.O.H.); the Departments of Surgery (A.G.) and Medicine (J.B.), University of Florida College of Medicine, Gainesville; the Department of Medicine, Southern Illinois University School of Medicine, Springfield (N.K.); and the Department of Medicine, University of Texas Medical Branch, Galveston (G.M.). Presented in part as an abstract (LB-22) at the 37th Interscience Conference on Antimicrobial Agents and Chemotherapy, Toronto, September 28–October 1, 1997.
Address reprint requests to Dr. Darouiche at the Veterans Affairs Medical Center, Infectious Disease Section (Rm. 4B-370), 2002 Holcombe Blvd., Houston, TX 77030, or at darouiche.rabih.o{at}houston.va.gov.
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