Comparison of Antimicrobial Impregnation With Tunneling of Long-term Central Venous Catheters: A Randomized Controlled Trial.
Darouiche, Rabih O. MD *+; Berger, David H. MD ++; Khardori, Nancy MD, PhD [//]; Robertson, Claudia S. MD [S]; Wall, Matthew J. Jr MD *++; Metzler, Michael H. MD **; Shah, Seema MD +; Mansouri, Mohammad D. BS *; Cerra-Stewart, Colleen MSN *; Versalovic, James MD, PhD [P]; Reardon, Michael J. MD ++; Raad, Issam I. MD ++
Annals of Surgery.
242(2):193-200, August 2005.
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Objective: We sought to compare the impact of antimicrobial impregnation to that of tunneling of long-term central venous catheters on the rates of catheter colonization and catheter-related bloodstream infection.
Summary Background Data: Tunneling of catheters constitutes a standard of care for preventing infections associated with long-term vascular access. Although antimicrobial coating of short-term central venous catheters has been demonstrated to protect against catheter-related bloodstream infection, the applicability of this preventive approach to long-term vascular access has not been established.
Methods: A prospective, randomized clinical trial in 7 university-affiliated hospitals of adult patients who required a vascular access for >=2 weeks. Patients were randomized to receive a silicone central venous catheter that was either impregnated with minocycline and rifampin or tunneled. The occurrence of catheter colonization and catheter-related bloodstream infection was determined.
Results: Of a total of 351 inserted catheters, 346 (186 antimicrobial-impregnated and 160 tunneled) were analyzed for catheter-related bloodstream infection. Clinical characteristics were comparable in the 2 study groups, but the antimicrobial-impregnated catheters remained in place for a shorter period of time (mean, 30.2 versus 43.8 days). Antimicrobial-impregnated catheters were as likely to be colonized as tunneled catheters (7.9 versus 6.3 per 1000 catheter-days). Bloodstream infection was 4 times less likely to originate from antimicrobial-impregnated than from tunneled catheters (0.36 versus 1.43 per 1000 catheter-days).
Conclusions: Antimicrobial impregnation of long-term central venous catheters may help obviate the need for tunneling of catheters.
(C) 2005 Lippincott Williams & Wilkins, Inc.