A comparison of two antimicrobial-impregnated central venous catheters

Rabih O. Darouiche, Issam I. Raad, Stephen O. Heard, John I. Thornby, Olivier C. Wenker, Andrea Gabrielli, Johannes Berg, Nancy Khardori, Hend Hanna, Ray Hachem, Richard L. Harris, Glen Mayhall

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Abstract

Background: The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective catheters. Methods: We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the catheters were cultured by both the roll-plate and the sonication methods. Peripheral-blood cultures were obtained if clinically indicated. Results: Of 865 catheters inserted, 738 (85 percent) produced culture results that could be evaluated. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters impregnated with minocycline and rifampin were 1/3 as likely to be colonized as catheters impregnated with chlorhexidine and silver sulfadiazine (28 of 356 catheters [7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), and catheter-related bloodstream infection was 1/12 as likely in catheters impregnated with minocycline and rifampin (1 of 356 [0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnated with chlorhexidine and silver sulfadiazine; P<0.002). Conclusions: The use of central venous catheters impregnated with minocycline and rifampin is associated with a lower rate of infection than the use of catheters impregnated with chlorhexidine and silver sulfadiazine.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalNew England Journal of Medicine
Volume340
Issue number1
DOIs
StatePublished - Jan 7 1999
Externally publishedYes

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Central Venous Catheters
Catheters
Silver Sulfadiazine
Minocycline
Chlorhexidine
Rifampin
Catheter-Related Infections
Sonication
Polyurethanes
Infection
Randomized Controlled Trials

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Darouiche, R. O., Raad, I. I., Heard, S. O., Thornby, J. I., Wenker, O. C., Gabrielli, A., ... Mayhall, G. (1999). A comparison of two antimicrobial-impregnated central venous catheters. New England Journal of Medicine, 340(1), 1-8. https://doi.org/10.1056/NEJM199901073400101

A comparison of two antimicrobial-impregnated central venous catheters. / Darouiche, Rabih O.; Raad, Issam I.; Heard, Stephen O.; Thornby, John I.; Wenker, Olivier C.; Gabrielli, Andrea; Berg, Johannes; Khardori, Nancy; Hanna, Hend; Hachem, Ray; Harris, Richard L.; Mayhall, Glen.

In: New England Journal of Medicine, Vol. 340, No. 1, 07.01.1999, p. 1-8.

Research output: Contribution to journalArticle

Darouiche, RO, Raad, II, Heard, SO, Thornby, JI, Wenker, OC, Gabrielli, A, Berg, J, Khardori, N, Hanna, H, Hachem, R, Harris, RL & Mayhall, G 1999, 'A comparison of two antimicrobial-impregnated central venous catheters', New England Journal of Medicine, vol. 340, no. 1, pp. 1-8. https://doi.org/10.1056/NEJM199901073400101
Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A et al. A comparison of two antimicrobial-impregnated central venous catheters. New England Journal of Medicine. 1999 Jan 7;340(1):1-8. https://doi.org/10.1056/NEJM199901073400101
Darouiche, Rabih O. ; Raad, Issam I. ; Heard, Stephen O. ; Thornby, John I. ; Wenker, Olivier C. ; Gabrielli, Andrea ; Berg, Johannes ; Khardori, Nancy ; Hanna, Hend ; Hachem, Ray ; Harris, Richard L. ; Mayhall, Glen. / A comparison of two antimicrobial-impregnated central venous catheters. In: New England Journal of Medicine. 1999 ; Vol. 340, No. 1. pp. 1-8.
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abstract = "Background: The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective catheters. Methods: We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the catheters were cultured by both the roll-plate and the sonication methods. Peripheral-blood cultures were obtained if clinically indicated. Results: Of 865 catheters inserted, 738 (85 percent) produced culture results that could be evaluated. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters impregnated with minocycline and rifampin were 1/3 as likely to be colonized as catheters impregnated with chlorhexidine and silver sulfadiazine (28 of 356 catheters [7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), and catheter-related bloodstream infection was 1/12 as likely in catheters impregnated with minocycline and rifampin (1 of 356 [0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnated with chlorhexidine and silver sulfadiazine; P<0.002). Conclusions: The use of central venous catheters impregnated with minocycline and rifampin is associated with a lower rate of infection than the use of catheters impregnated with chlorhexidine and silver sulfadiazine.",
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AU - Darouiche, Rabih O.

AU - Raad, Issam I.

AU - Heard, Stephen O.

AU - Thornby, John I.

AU - Wenker, Olivier C.

AU - Gabrielli, Andrea

AU - Berg, Johannes

AU - Khardori, Nancy

AU - Hanna, Hend

AU - Hachem, Ray

AU - Harris, Richard L.

AU - Mayhall, Glen

PY - 1999/1/7

Y1 - 1999/1/7

N2 - Background: The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective catheters. Methods: We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the catheters were cultured by both the roll-plate and the sonication methods. Peripheral-blood cultures were obtained if clinically indicated. Results: Of 865 catheters inserted, 738 (85 percent) produced culture results that could be evaluated. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters impregnated with minocycline and rifampin were 1/3 as likely to be colonized as catheters impregnated with chlorhexidine and silver sulfadiazine (28 of 356 catheters [7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), and catheter-related bloodstream infection was 1/12 as likely in catheters impregnated with minocycline and rifampin (1 of 356 [0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnated with chlorhexidine and silver sulfadiazine; P<0.002). Conclusions: The use of central venous catheters impregnated with minocycline and rifampin is associated with a lower rate of infection than the use of catheters impregnated with chlorhexidine and silver sulfadiazine.

AB - Background: The use of central venous catheters impregnated with either minocycline and rifampin or chlorhexidine and silver sulfadiazine reduces the rates of catheter colonization and catheter-related bloodstream infection as compared with the use of unimpregnated catheters. We compared the rates of catheter colonization and catheter-related bloodstream infection associated with these two kinds of antiinfective catheters. Methods: We conducted a prospective, randomized clinical trial in 12 university-affiliated hospitals. High-risk adult patients in whom central venous catheters were expected to remain in place for three or more days were randomly assigned to undergo insertion of polyurethane, triple-lumen catheters impregnated with either minocycline and rifampin (on both the luminal and external surfaces) or chlorhexidine and silver sulfadiazine (on only the external surface). After their removal, the tips and subcutaneous segments of the catheters were cultured by both the roll-plate and the sonication methods. Peripheral-blood cultures were obtained if clinically indicated. Results: Of 865 catheters inserted, 738 (85 percent) produced culture results that could be evaluated. The clinical characteristics of the patients and the risk factors for infection were similar in the two groups. Catheters impregnated with minocycline and rifampin were 1/3 as likely to be colonized as catheters impregnated with chlorhexidine and silver sulfadiazine (28 of 356 catheters [7.9 percent] vs. 87 of 382 [22.8 percent], P<0.001), and catheter-related bloodstream infection was 1/12 as likely in catheters impregnated with minocycline and rifampin (1 of 356 [0.3 percent], vs. 13 of 382 [3.4 percent] for those impregnated with chlorhexidine and silver sulfadiazine; P<0.002). Conclusions: The use of central venous catheters impregnated with minocycline and rifampin is associated with a lower rate of infection than the use of catheters impregnated with chlorhexidine and silver sulfadiazine.

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