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Published on: July 13, 2019
Comparison of antimicrobial impregnation with tunneling of long-term central venous catheters: a randomized
Rabih O Darouiche1, David H Berger, Nancy Khardori
1Center for Prostheses Infection, Baylor College of Medicine, Houston, Texas 77030, USA. rdarouiche@aol.com
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 > or = 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.
Insights
Antimicrobial impregnation of long-term central venous catheters significantly reduced bloodstream infections compared to tunneling. This approach may eliminate the need for tunneling in preventing catheter-related infections.
Area of Science:
- Infectious Diseases
- Medical Devices
- Clinical Trials
Background:
- Tunneling is standard for preventing long-term central venous catheter infections.
- Antimicrobial coating is effective for short-term catheters but not established for long-term use.
Purpose of the Study:
- Compare antimicrobial impregnation versus tunneling for long-term central venous catheters.
- Evaluate impact on catheter colonization and bloodstream infection rates.
Main Methods:
- Prospective, randomized clinical trial across 7 university hospitals.
- Adult patients requiring central venous access for >= 2 weeks.
- Silicone catheters: minocycline/rifampin impregnated vs. tunneled.
Main Results:
- 346 catheters analyzed; antimicrobial-impregnated catheters in place for shorter duration (30.2 vs 43.8 days).
- Catheter colonization rates were similar (7.9 vs 6.3 per 1000 catheter-days).
- Bloodstream infections were 4x less likely with antimicrobial-impregnated catheters (0.36 vs 1.43 per 1000 catheter-days).
Conclusions:
- Antimicrobial impregnation is effective in reducing bloodstream infections for long-term central venous catheters.
- This method may serve as an alternative to catheter tunneling.
