Prevention of Central Venous Catheter-Related Bloodstream Infection by Use of an Antiseptic-Impregnated Catheter. A Randomized, Controlled Trial

Ann Intern Med. 1997 Aug 15;127(4):257-66. doi: 10.7326/0003-4819-127-4-199708150-00001.

Abstract

Background: Bloodstream infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these infections are needed.

Objective: To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related infection, 2) patient tolerance of this catheter, and 3) the sources of bloodstream infection originating from noncuffed, multilumen central venous catheters.

Design: Randomized, controlled clinical trial.

Setting: Medical-surgical intensive care unit of a 450-bed university hospital.

Participants: 158 adults scheduled to receive a central venous catheter; 403 catheters were studied.

Intervention: Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine.

Measurements: Catheters were studied for colonization and catheter-related bloodstream infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated bloodstream infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping.

Results: Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce bloodstream infection (1.0 compared with 4.7 infections per 100 catheters; 1.6 compared with 7.6 infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related bloodstream infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no infections with these organisms occurred in the antiseptic catheter group (P = 0.003). No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 infections per 1000 catheter-days).

Conclusions: The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Infective Agents, Local / economics
  • Anti-Infective Agents, Local / therapeutic use*
  • Catheterization, Central Venous / adverse effects*
  • Catheterization, Central Venous / economics
  • Catheters, Indwelling / adverse effects
  • Catheters, Indwelling / economics
  • Catheters, Indwelling / microbiology
  • Chlorhexidine / economics
  • Chlorhexidine / therapeutic use*
  • Cost-Benefit Analysis
  • Cross Infection / prevention & control
  • DNA, Bacterial / isolation & purification
  • DNA, Viral / isolation & purification
  • Female
  • Humans
  • Male
  • Middle Aged
  • Risk
  • Sepsis / economics
  • Sepsis / etiology
  • Sepsis / microbiology
  • Sepsis / prevention & control*
  • Silver Sulfadiazine / economics
  • Silver Sulfadiazine / therapeutic use*
  • Treatment Outcome

Substances

  • Anti-Infective Agents, Local
  • DNA, Bacterial
  • DNA, Viral
  • Chlorhexidine
  • Silver Sulfadiazine