Prevention of transmission of multidrug-resistant organisms during catheter exchange using antimicrobial catheters

Antimicrob Agents Chemother. 2014 Sep;58(9):5291-6. doi: 10.1128/AAC.02886-14. Epub 2014 Jun 23.


Exchanging a central venous catheter (CVC) over a guide wire for a fresh uncoated CVC in the presence of bacteremia can result in cross-infection of the newly exchanged CVC. A recent retrospective clinical study showed that exchanging a catheter over a guide wire in the presence of bacteremia using an antimicrobial minocycline-rifampin (M/R) catheter may improve outcomes. To expand on this, we developed an in vitro cross-contamination model of exchange to evaluate the efficacy of different antimicrobial CVCs in preventing cross-contamination of multidrug-resistant organisms during exchange. Uncoated CVCs were allowed to form biofilm by methicillin-resistant Staphylococcus aureus (MRSA), Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans. After 24 h, the biofilm-colonized CVCs were placed in a glass tube containing bovine calf serum plus Mueller-Hinton broth, and each catheter was exchanged over a guide wire for a fresh uncoated or an M/R-, chlorhexidine-silver sulfadiazine (CHX/SS)-, or chlorhexidine-M/R (CHX-M/R)-coated CVC. Cross-contamination of exchanged catheters was enumerated by sonication and quantitative plating methods. The exchange of M/R CVCs completely prevented cross-contamination by MRSA biofilms compared to control exchanged CVCs (P<0.0001). Exchange with CHX/SS CVCs reduced but did not completely prevent cross-contamination by MRSA (P=0.005). Exchange with CHX-M/R CVCs completely prevented cross-contamination by MRSA, P. aeruginosa, and C. albicans biofilms (P<0.0001). Furthermore, CHX-M/R CVCs were superior to M/R CVCs against P. aeruginosa and C. albicans (P=0.003) and were superior to CHX/SS CVCs against MRSA and P. aeruginosa (P=0.01). In conclusion, exchange with the novel CHX-M/R CVC was the only exchange effective in completely and concurrently preventing cross-contamination from bacteria and Candida.

MeSH terms

  • Anti-Bacterial Agents / administration & dosage
  • Anti-Bacterial Agents / therapeutic use
  • Biofilms / drug effects
  • Catheter-Related Infections / microbiology
  • Catheter-Related Infections / prevention & control*
  • Catheter-Related Infections / transmission
  • Catheterization, Central Venous / adverse effects
  • Catheterization, Central Venous / methods
  • Central Venous Catheters / adverse effects
  • Central Venous Catheters / microbiology*
  • Chlorhexidine / administration & dosage
  • Chlorhexidine / therapeutic use
  • Disinfectants / administration & dosage
  • Disinfectants / therapeutic use
  • Drug Resistance, Multiple, Bacterial
  • Drug Therapy, Combination
  • Humans
  • Minocycline / administration & dosage
  • Minocycline / therapeutic use
  • Rifampin / administration & dosage
  • Rifampin / therapeutic use


  • Anti-Bacterial Agents
  • Disinfectants
  • Minocycline
  • Chlorhexidine
  • Rifampin