Which antimicrobial impregnated central venous catheter should we use? Modeling the costs and outcomes of antimicrobial catheter use

Am J Infect Control. 2003 Feb;31(1):1-8. doi: 10.1067/mic.2003.35.


Background: Catheter-related bloodstream infections are costly and associated with substantial morbidity and mortality. Trials suggest that central venous catheters impregnated with minocycline/rifampin, although more expensive, are clinically superior to chlorhexidine/silver sulfadiazine impregnated catheters. It remains unclear whether minocycline/rifampin catheters are cost-effective for all high-risk patients or only those requiring longer-term catheterization.

Methods: We developed a series of decision models with patient-level clinical trial data to determine whether minocycline/rifampin catheters are cost-effective for patients requiring various durations of catheterization. We calculated incremental cost-effectiveness ratios for patients catheterized for durations ranging from 1 to 25 days.

Results: The data were too sparse to estimate cost-effectiveness for patients catheterized less than 8 days. The probability that minocycline/rifampin catheters were cost-effective compared with chlorhexidine/silver sulfadiazine catheters in patients catheterized for 8 days was 91%. The probability that the minocycline/rifampin catheters in patients catheterized 13 days or longer resulted in cost savings was more than 95%.

Conclusions: Our analysis suggests that central venous catheters coated with minocycline/rifampin are cost-effective for patients catheterized for at least 1 week and lead to overall cost savings when patients are catheterized for 2 weeks or longer. Policies for the use of antimicrobial catheters in high-risk patients should reflect patients' expected duration of catheterization.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Infective Agents / administration & dosage
  • Anti-Infective Agents / economics*
  • Bacteremia / prevention & control*
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / economics
  • Catheterization, Central Venous / methods*
  • Catheters, Indwelling / economics*
  • Catheters, Indwelling / microbiology
  • Chlorhexidine / administration & dosage
  • Chlorhexidine / economics
  • Cost-Benefit Analysis
  • Decision Support Techniques*
  • Drug Delivery Systems
  • Humans
  • Middle Aged
  • Minocycline / administration & dosage
  • Minocycline / economics*
  • Quality-Adjusted Life Years
  • Rifampin / administration & dosage
  • Rifampin / economics*
  • Sensitivity and Specificity
  • Silver Sulfadiazine / administration & dosage
  • Silver Sulfadiazine / economics
  • Time Factors
  • United States


  • Anti-Infective Agents
  • Minocycline
  • Chlorhexidine
  • Rifampin
  • Silver Sulfadiazine