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, Steven J. Lisco, Pamela A. Lipsett, Irish M. Perl, Kevin Keating, Joseph M. Civetta, Leonard A. Mermel, David Lee, E. Patchen Dellinger, Michael Donahoe, David Giles, Michael A. Pfaller, Dennis G. Maki, Robert Sherertz

Research output: Contribution to journalArticle

178 Citations (Scopus)

Abstract

Background: Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed. Objective: To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. Design: Multicenter, randomized, double-blind, controlled trial. Setting: 9 university-affiliated medical centers. Patients: 780 patients in intensive care units who required central venous catheterization. Intervention: Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. Measurements: The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. Results: Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. Limitations: The antiseptic catheter was not compared with an antibiotic-coated catheter, and no conclusion can be made regarding its effect on bloodstream infection. Conclusions: The second-generation chlorhexidine-silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.

Original languageEnglish (US)
Pages (from-to)570-580+I36
JournalAnnals of internal medicine
Volume143
Issue number8
DOIs
StatePublished - Oct 18 2005

Fingerprint

Silver Sulfadiazine
Catheter-Related Infections
Chlorhexidine
Catheters
Randomized Controlled Trials
Local Anti-Infective Agents

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections : A randomized, controlled trial. / Rupp, Mark E.; Lisco, Steven J.; Lipsett, Pamela A.; Perl, Irish M.; Keating, Kevin; Civetta, Joseph M.; Mermel, Leonard A.; Lee, David; Dellinger, E. Patchen; Donahoe, Michael; Giles, David; Pfaller, Michael A.; Maki, Dennis G.; Sherertz, Robert.

In: Annals of internal medicine, Vol. 143, No. 8, 18.10.2005, p. 570-580+I36.

Research output: Contribution to journalArticle

Rupp, ME, Lisco, SJ, Lipsett, PA, Perl, IM, Keating, K, Civetta, JM, Mermel, LA, Lee, D, Dellinger, EP, Donahoe, M, Giles, D, Pfaller, MA, Maki, DG & Sherertz, R 2005, 'Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: A randomized, controlled trial', Annals of internal medicine, vol. 143, no. 8, pp. 570-580+I36. https://doi.org/10.7326/0003-4819-143-8-200510180-00007
Rupp, Mark E. ; Lisco, Steven J. ; Lipsett, Pamela A. ; Perl, Irish M. ; Keating, Kevin ; Civetta, Joseph M. ; Mermel, Leonard A. ; Lee, David ; Dellinger, E. Patchen ; Donahoe, Michael ; Giles, David ; Pfaller, Michael A. ; Maki, Dennis G. ; Sherertz, Robert. / Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections : A randomized, controlled trial. In: Annals of internal medicine. 2005 ; Vol. 143, No. 8. pp. 570-580+I36.
@article{1a7e7391d3bd44948025291638eee888,
title = "Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections: A randomized, controlled trial",
abstract = "Background: Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed. Objective: To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. Design: Multicenter, randomized, double-blind, controlled trial. Setting: 9 university-affiliated medical centers. Patients: 780 patients in intensive care units who required central venous catheterization. Intervention: Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. Measurements: The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. Results: Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95{\%} CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. Limitations: The antiseptic catheter was not compared with an antibiotic-coated catheter, and no conclusion can be made regarding its effect on bloodstream infection. Conclusions: The second-generation chlorhexidine-silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.",
author = "Rupp, {Mark E.} and Lisco, {Steven J.} and Lipsett, {Pamela A.} and Perl, {Irish M.} and Kevin Keating and Civetta, {Joseph M.} and Mermel, {Leonard A.} and David Lee and Dellinger, {E. Patchen} and Michael Donahoe and David Giles and Pfaller, {Michael A.} and Maki, {Dennis G.} and Robert Sherertz",
year = "2005",
month = "10",
day = "18",
doi = "10.7326/0003-4819-143-8-200510180-00007",
language = "English (US)",
volume = "143",
pages = "570--580+I36",
journal = "Annals of Internal Medicine",
issn = "0003-4819",
publisher = "American College of Physicians",
number = "8",

}

TY - JOUR

T1 - Effect of a second-generation venous catheter impregnated with chlorhexidine and silver sulfadiazine on central catheter-related infections

T2 - A randomized, controlled trial

AU - Rupp, Mark E.

AU - Lisco, Steven J.

AU - Lipsett, Pamela A.

AU - Perl, Irish M.

AU - Keating, Kevin

AU - Civetta, Joseph M.

AU - Mermel, Leonard A.

AU - Lee, David

AU - Dellinger, E. Patchen

AU - Donahoe, Michael

AU - Giles, David

AU - Pfaller, Michael A.

AU - Maki, Dennis G.

AU - Sherertz, Robert

PY - 2005/10/18

Y1 - 2005/10/18

N2 - Background: Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed. Objective: To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. Design: Multicenter, randomized, double-blind, controlled trial. Setting: 9 university-affiliated medical centers. Patients: 780 patients in intensive care units who required central venous catheterization. Intervention: Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. Measurements: The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. Results: Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. Limitations: The antiseptic catheter was not compared with an antibiotic-coated catheter, and no conclusion can be made regarding its effect on bloodstream infection. Conclusions: The second-generation chlorhexidine-silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.

AB - Background: Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed. Objective: To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance. Design: Multicenter, randomized, double-blind, controlled trial. Setting: 9 university-affiliated medical centers. Patients: 780 patients in intensive care units who required central venous catheterization. Intervention: Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine. Measurements: The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored. Results: Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group. Limitations: The antiseptic catheter was not compared with an antibiotic-coated catheter, and no conclusion can be made regarding its effect on bloodstream infection. Conclusions: The second-generation chlorhexidine-silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.

UR - http://www.scopus.com/inward/record.url?scp=26944435958&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=26944435958&partnerID=8YFLogxK

U2 - 10.7326/0003-4819-143-8-200510180-00007

DO - 10.7326/0003-4819-143-8-200510180-00007

M3 - Article

C2 - 16230723

AN - SCOPUS:26944435958

VL - 143

SP - 570-580+I36

JO - Annals of Internal Medicine

JF - Annals of Internal Medicine

SN - 0003-4819

IS - 8

ER -