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Reducing catheter-associated infections with silver-impregnated catheters in long-term therapy of children
R T Carbon1, S Lugauer, U Geitner
1Abt. für Kinderchirurgie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany.
Insights
Catheter-associated infections (CAI) are a significant risk for long-term central venous catheters. Silver-impregnated catheters show promise in preventing CAI in pediatric patients, significantly reducing infection rates compared to conventional types.
Area of Science:
- Medical Sciences
- Infectious Diseases
- Pediatric Medicine
Background:
- Central venous catheters provide essential vascular access for nutrition and infusions.
- Catheter-associated infections (CAI) represent the primary threat to the efficacy and safety of these devices.
- Existing preventive measures for CAI have limitations.
Purpose of the Study:
- To evaluate the incidence of CAI in pediatric patients with conventional long-term central venous catheters.
- To compare the efficacy of silver-impregnated catheters versus conventional catheters in preventing CAI in pediatric patients.
Main Methods:
- Retrospective analysis of 60 conventional catheters in 50 pediatric patients (1990-1995).
- Prospective, randomized study comparing 20 silver-impregnated catheters with 21 conventional catheters.
- Bacteriological analysis of catheter tips and blood cultures for CAI diagnosis.
Main Results:
- Retrospective study: CAI incidence of 1 per 1,000 catheter days; 5% with bacteriological CAI, 8.3% with septic clinical picture.
- Prospective study: Silver catheters showed sterile findings; control catheters had 3 CAI cases (1.18 per 1,000 days).
- One patient on control catheter developed septic shock with Pseudomonas aeruginosa.
Conclusions:
- Conventional long-term central venous catheters are associated with a notable incidence of CAI in pediatric therapy.
- Silver-impregnated catheters demonstrate superior performance in preventing CAI, with zero infections observed in the tested group.
- Further investigation into silver-impregnated catheters is warranted to reduce CAI risks in pediatric patients.
Abstract:
Central venous long-term catheters offer reliable, large-lumen vascular access with high flow rates for delivery of nutrition or for cell-containing infusions and perfusions. Catheter-associated infections (CAI) pose the greatest threat to such vascular access, despite existing preventive measures. In this article one prospective and one retrospective study of CAI in pediatric therapy are presented. Study I: A retrospective investigation from 1990 through 1995 of 60 conventional long-term catheters in 50 patients. The total number of days in which the catheters were in place was 11,818. The calculated CAI incidence was 1 per 1,000 days of catheter insertion. Bacteriologically demonstrated CAI (identical isolate on the catheter tip and in a blood culture) occurred in three instances (5%). Five cases (8.3%) were diagnosed with a therapy-resistant, septic clinical picture. Study II: A prospective, randomized comparison of long-term silver-impregnated (Erlanger silver catheters) and control catheters (Quinton Instrument Co.) was made with 41 patients (20 with a silver catheter, 21 with a Quinton catheter). To date, the silver catheters have been distinguished by sterile bacteriological findings, whereas three cases of CAI have been demonstrated with the comparative catheters. One patient recently underwent intensive care after becoming unstable with signs of septic shock and demonstrable Pseudomonas aeruginosa, and two other patients manifested coagulase-negative staphylococci on the catheter tips. In three of nine control catheters an incidence of 1.18 per 1,000 days of indwelling catheters was found, whereas no CAI has occurred with the eight microbiologically tested silver catheters.