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1-9 Physicians from the Intensive Care Unit of Casa de Saude Sao Jose, Rio de Janeiro (RJ), Brazil. 10 – Physician from the Intensive Care Unit of Casa de Saude Sao Jose, Rio de Janeiro (RJ), Brazil and Institute for Clinical Research Evandro Chagas FIOCRUZ, Rio de Janeiro (RJ), Brazil. We wish to thank Dr. Helcio Griffhorn for his interest in our work. We have shown that octogenarians present a longer stay, higher incidence of complications and higher mortality, with worse peri-operative severity of illness. However, nonelderly and sexagenarian patients had similar performance, disclosing increased life expectancy and quality in Brazilian population.(1) Septuagenarian were characterized by hybrid results, showing increased severity of disease, higher incidence of postoperative atrial fibrillation and reoperation, however ICU length of stay and mortality were similar to those of younger groups. Worse performance of elderly can result from need for urgent surgery, efforts to prolong treatment with drugs and coronary angioplasty procedures. Blood transfusion was more often used at preoperative of septuagenarians and octogenarians (critical levels of anemia with advanced age or greater use of blood products may significantly influence outcomes).(2,3) The study included only patients submitted to coronary artery bypass graft (CABG) as the main surgery although a significant number also had an indication for valve replacement, secondarily. As commented, mortality of CABG patients who needed valve replacement is higher (15.5%). There were 61 orovalvular surgeries during the study’s period, with 6 deaths, but they were excluded because we wanted to specifically analyze a homogeneous group of CABG. Presence of aortic valve disease may increase surgical and extracorporeal circulation (ECC) duration, however there was no impact on the incidence of complications, perhaps due to exclusion of most orovalvular surgeries. Of the 343 cardiac surgeries in this time period, 11(3%) were performed without ECC. Duration of surgery and morbidity may be less frequent with this approach,(4) but could increase heterogeneity of the study group. Decision of the operation technique always rested upon the surgical team before admission. If the complications most often found in elderly (atrial fibrillation, left ventricle failure, significant thoracic bleeding, acute renal dysfunction and nosocomial sepsis) were added to high frequency of urgent surgeries and longer time of ECC, there are reasons for higher morbidity and mortality of elderly patients. Finally, postoperative transient inflammatory reaction that comes together with ECC was analyzed in some studies. Cytokines, as macrophage migration inhibitor factor, interleukin 6 and monocyte chemoattractant protein, undergo a significant early increase after induction of anesthesia and return to baseline levels after 24 hours, and(5) correlate with levels of organ dysfunctions. Researchers are looking for predictive biomarkers of postoperative morbidity, mainly in the elderly. Received from the Intensive Care Unit of the Casa de Saude Sao Jose, Rio de Janeiro (RJ), Brazil. Submitted on January 16, 2009 Accepted on January 31, 2009

JUSTIFICATIVA E OBJETIVOS: A bacteremia associada a cateter venoso central (CVC) aumenta a morbidade e mortalidade hospitalar em pacientes internados em unidade de terapia intensiva (UTI). Os cateteres recobertos com rifampicina e minociclina (RM) reduzem a freqüência de colonização e bacteremia. No entanto, resultados de estudos recentes questionaram o seu impacto clínico. O objetivo deste estudo foi comparar a incidência de colonização e bacteremia associada à CVC recobertos com RM e não recobertos numa coorte de pacientes admitidos em UTI. METODO: Estudo prospectivo, controlado em UTI mista clínico-cirúrgica. Os pacientes receberam um CVC recobertos com RM ou não recoberto. Após remoção do CVC, foi feita cultura de ponta do cateter e hemoculturas foram coletadas. Avaliou-se a freqüência de colonização e bacteremia. RESULTADOS: Cento e vinte CVC foram inseridos e 100 puderam ser avaliados, 49 no grupo não recobertos e 51 no grupo recoberto. As características clínicas foram similares nos 2 grupos. Dois casos de bacteremia associada ao cateter (BAC) (3,9%) ocorreram em pacientes que receberam CVC recobertos com RM comparado a 5 (10,2%) casos de BAC no grupo não recobertos (p = 0,26). Seis (11,8%) cateteres recobertos foram colonizados, comparados a 14 (28,6%) no grupo não recoberto (p = 0,036). A análise de Kaplan-Meier não demonstrou diferença no risco de colonização ou BAC entre os dois grupos estudados. A taxa de BAC foi de 4,7 por 1000 cateteres-dia no grupo com CVC recobertos e 11,4 por 1000 cateteres-dia no grupo que recebeu cateteres não recobertos (p = 0,45). CONCLUSÕES: Neste estudo piloto, demonstrou-se menor freqüência de colonização em cateteres recobertos com RM, quando comparados a cateteres não recobertos. A freqüência de BAC não foi diferente entre os dois grupos. BACKGROUND AND OBJECTIVES: Nosocomial catheter related bloodstream infections (CR-BSI) increase morbidity and mortality in critically ill patients. Central venous catheters (CVC) coated with rifampin and minocycline (RM) decrease rates of colonization and CR-BSI. However, recent trials challenged the clinical impact of such catheters. We designed this trial to compare rates of colonization and CR-BSI in RM catheters and controls in a cohort of critically ill patients in Brazil. METHODS: Prospective, controlled trial conducted in one medico-surgical ICU. Patients were assigned to receive a control or RM CVC. After removal, tips were cultured in association with blood cultures. Rates of colonization and CR-BSI were recorded. RESULTS: Among 120 catheters inserted, 100 could be evaluated, 49 in the uncoated and 51 in the coated group. Clinical characteristics of patients were similar in the two groups. Two cases of CR-BSI (3.9%) occurred in patients who received RM catheters compared with 5 (10.2%) in the uncoated group (p = 0.26). Six RM catheters (11.8%) were colonized compared with 14 (28.6%) control catheters (p = 0.036). Kaplan-Meier analysis showed no significant differences in the risk of colonization or CR-BSI. Rates of CR-BSI were 4.7 per 1000 catheter-days in the RM coated group compared to 11.4 per 1000 catheter days in the uncoated group (p = 0.45). CONCLUSIONS: In this pilot study, we showed lower rates of colonization in RM coated when compared with uncoated catheters. Incidence and rates of CR-BSI were similar in the two groups.