Antimicrobial Central Venous Catheters vs. Uncoated Central Venous Catheters in Reducing Catheter-Related Bloodstream...

Background and Objectives: Central venous catheters (CVCs) are widely used in intensive care units (ICUs) but are associated with catheter-related bloodstream infections (CRBSIs), which increase morbidity, mortality, and healthcare costs. Antimicrobial-impregnated catheters, including chlorhexidine-silver sulfadiazine (CSS)-coated CVCs, have been proposed to reduce this risk. This study evaluated the effectiveness of CSS-coated CVCs in preventing CRBSIs in ICU patients. Materials and Methods: A retrospective multicenter study was conducted in two ICUs in Naples, Italy. Patients admitted between October and December 2020 who received standard uncoated CVCs (Group A) were compared with patients admitted between October and December 2021 who received CSS-coated CVCs (Group B). Inclusion criteria were age 18-89 years, ICU admission with CVC placement, and negative blood cultures at admission. The primary outcome was the incidence of CRBSI, defined according to microbiological criteria consistent with current guidelines. The secondary outcome was the number of catheter removals due to confirmed CRBSI. Results: A total of 320 patients were included (170 in Group A and 150 in Group B). Baseline demographic characteristics and ICU admission diagnoses were comparable between groups. Microbiologically confirmed CRBSI incidence was significantly lower in Group B than in Group A (6.4% vs. 31.7%, p < 0.0001), corresponding to infection rates of 1.48 vs. 6.95 per 1000 catheter-days, respectively (p < 0.0001). Patients in Group B also required fewer catheter removals due to CRBSI (mean 1.6 vs. 3.2 per patient, p < 0.0001). Logistic regression confirmed a significantly lower risk of CRBSI with CSS-coated CVCs (OR 0.15; 95% CI 0.06-0.32). Conclusions: CSS-coated CVCs were associated with a significant reduction in CRBSI incidence and catheter replacement rates in ICU patients. However, given the retrospective design, univariable analysis, and highly unequal pandemic-related systemic stressors between the two periods, these findings demonstrate a clinical association rather than direct causation, and should be interpreted with caution due to potential residual confounding.