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Erschienen in:
01.04.2004 | Original
Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients
Erschienen in: Intensive Care Medicine | Ausgabe 4/2004
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Objective
To compare the incidence of catheter colonization and catheter-related bloodstream infections between heparin-coated catheters and those coated with a synergistic combination of chlorhexidine and silver sulfadiazine.
Design
Randomized, controlled clinical trial.
Setting
A 20-bed medical-surgical intensive care unit.
Patients
A total of 180 patients requiring the insertion of a trilumen central venous catheter.
Interventions
Patients were randomized to receive either a trilumen heparin or chlorhexidine and silver sulfadiazine-coated catheter.
Measurements
Catheter colonization was defined by a semiquantitative catheter tip culture yielding 15 or more colony-forming units or quantitative culture of 1,000 or more colony-forming units/ml. Catheter-related bloodstream infection as the isolation of the same microorganism from a peripheral blood culture and catheter tip.
Results
A total of 260 catheters were cultured. Out of 132 heparin-coated catheters, 29 were colonized and out of 128 chlorhexidine and silver sulfadiazine- coated catheters, 13 were colonized (p=0.03), relative risk RR=2.16 (1.18–3.97). This represents an incidence of 23.5 and 11.5 episodes of catheter colonization per 1,000 catheter-days, respectively (p=0.0059), RR=2.04 (1.05–3.84). Microorganisms isolated in catheter colonization from heparin-coated catheters were gram-positive cocci 23, gram-negative bacilli 7, and Candida spp 4. In chlorhexidine and silver sulfadiazine-coated catheters were gram-positive cocci 6 and gram-negative bacilli 11 (p=0.009). The incidence of catheter-related bloodstream infections per 1,000 catheter-days was 3.24 in heparin-coated catheters and 2.6 in chlorhexidine and silver sulfadiazine-coated catheters (p=0.79), RR=1.22 (0.27–5.43).
Conclusions
In critically ill patients the use of trilumen central venous catheters coated with chlorhexidine and silver sulfadiazine reduced the risk of catheter colonization due to prevention of gram-positive cocci and Candida spp.