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1. A systematic review comparing the relative effectiveness of antimicrobial-coated catheters in intensive care units

Author

David Fraenkel, David Cook, Michael Whitby, Diana Battistutta, Nicholas Graves, Kate Halton, Peter Collignon, and Prabha Ramritu

Subjects
Catheterization, Central Venous, medicine.medical_specialty, Silver, Epidemiology, medicine.drug_class, medicine.medical_treatment, Minocycline, Silver sulfadiazine, Catheterization, law.invention, Antiseptic, law, Sepsis, Intensive care, medicine, Humans, Intensive care medicine, Platinum, Cross Infection, business.industry, Health Policy, Chlorhexidine, Public Health, Environmental and Occupational Health, Intensive care unit, Carbon, Anti-Bacterial Agents, Intensive Care Units, Catheter, Infectious Diseases, Relative risk, Rifampin, business, Central venous catheter, medicine.drug
Abstract

Background Bloodstream infection related to a central venous catheter is a substantial clinical and economic problem. To develop policy for managing the risks of these infections, all available evidence for prevention strategies should be synthesized and understood. Methods We evaluate evidence (1985-2006) for short-term antimicrobial-coated central venous catheters in lowering rates of catheter-related bloodstream infection (CRBSI) in the adult intensive care unit. Evidence was appraised for inclusion against predefined criteria. Data extraction was by 2 independent reviewers. Thirty-four studies were included in the review. Antiseptic, antibiotic, and heparin-coated catheters were compared with uncoated catheters and one another. Metaanalysis was used to generate summary relative risks for CRBSI and catheter colonization by antimicrobial coating. Results Externally impregnated chlorhexidine/silver sulfadiazine catheters reduce risk of CRBSI relative to uncoated catheters (RR, 0.66; 95% CI: 0.47-0.93). Minocycline and rifampicin-coated catheters are significantly more effective relative to CHG/SSD catheters (RR, 0.12; 95% CI: 0.02-0.67). The new generation chlorhexidine/silver sulfadiazine catheters and silver, platinum, and carbon-coated catheters showed nonsignificant reductions in risk of CRBSI compared with uncoated catheters. Conclusion Two decades of evidence describe the effectiveness of antimicrobial catheters in preventing CRBSI and provide useful information about which catheters are most effective. Questions surrounding their routine use will require supplementation of this trial evidence with information from more diverse sources.

Published
2008
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2. List of Contributors

Author

Timothy M Alce, Sumesh Arora, Thearina de Beer, Rinaldo Bellomo, Andrew D Bersten, Tim Bowles, Jeremy P Campbell, Alastair C Carr, Marianne J Chapman, Kai Man Chan, Gordon YS Choi, Christine Chung, Jeremy Cohen, David Collins, D James Cooper, Evelyn Corner, Simon Cottam, Sarah Cox, Lester AH Critchley, Andrew R Davies, Anthony Delaney, Rishi H-P Dhillon, Tavey Dorofaeff, Graeme J Duke, Cyrus Edibam, Evan R Everest, Simon Finfer, Malcolm M Fisher, Oliver J Flower, Carole Foot, David Fraenkel, Steven T Galluccio, A Raffaele De Gaudio, Tony Gin, Charles D Gomersall, Anthony C Gordon, Munita Grover, Pascale Gruber, Anish Gupta, Jonathan M Handy, Sara Hanna, James Hatcher, Felicity H Hawker, Michelle Hayes, Victoria Heaviside, Liz Hickson, Alisa Higgins, Pierre Hoffmeyer, Andrew Holt, Matthew R Hooper, Li C Hsee, Nicholas Ioannou, James P Isbister, Matthias Jacob, Paul James, Paul Cassius Jansz, Mandy O Jones, Gavin M Joynt, James A Judson, Richard Keays, Angus M Kennedy, Ian Kerridge, Geoff Knight, Stephen W Lam, Richard Leonard, Daniel Lew, Alexander M Man Ying Li, Jeffrey Lipman, Pieter HW Lubbert, Peter S Macdonald, David P Mackie, Matthew Maiden, Colin McArthur, Kevin McCaffery, Steve McGloughlin, Johnny Millar, Wai Ka Ming, Fiona H Moffatt, Thomas J Morgan, Peter T Morley, John A Myburgh, Michael MG Mythen, Matthew T Naughton, Alistair D Nichol, Gerry O'Callaghan, Helen I Opdam, Aaisha Opel, Alexander A Padiglione, Simon PG Padley, Valerie Page, Mark Palazzo, Sandra L Peake, Vincent Pellegrino, Michael E Pelly, David Pilcher, Didier Pittet, Kevin Plumpton, Brad Power, Susanna Price, Raymond F Raper, Michael C Reade, Bernard Riley, Shelley D Riphagen, Hayley Robinson, Vineet V Sarode, Hugo Sax, Manoj K Saxena, Oliver R Segal, Frank Shann, Pratik Sinha, Ramachandran Sivakumar, George Skowronski, Anthony J Slater, Martin Smith, Neil Soni, Stephen J Streat, Richard Strickland, David J Sturgess, Christian P Subbe, Joseph JY Sung, Chee Wee Tan, Guido Tavazzi, Peter D (Toby) Thomas, James Tibballs, Luke E Torre, David Treacher, David V Tuxen, Ilker Uçkay, Balasubramanian Venkatesh, Jacqueline EHM Vet, Marcela P Vizcaychipi, Adrian J Wagstaff, Carl S Waldmann, Christopher M Ward, John R Welch, Julia Wendon, Mary White, Ubbo F Wiersema, Timothy Wigmore, Christopher Willars, Wan Tsz Pan Winnie, David M Wood, Duncan LA Wyncoll, and Steve M Yentis

Published
2014
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4. Contributors

Author

Rinaldo Bellomo, Andrew D Bersten, David Bihari, Stephen Brett, Craig Carr, Jeremy Cohen, Frances B Colreavy, D J (Jamie) Cooper, Lester A H Critchley, Andrew R Davies, Anthony Delaney, Karl D Donovan, Graeme Duke, Alan W Duncan, Cyrus Edibam, Evan Everest, Patricia Figgis, Simon Finfer, Malcolm McD Fisher, David Fraenkel, Martyn A H French, Raffaele de Gaudio, Tony Gin, David R Goldhill, Charles D Gomersall N, Munita Grover, Geoff A Gutteridge, Jonathan Handy, Felicity Hawker, Michelle Hayes, Victoria Heaviside, Peter V van Heerden, Robert D Henning, Bernard E F Hockings, Andrew Holt, Anwar Hussein, James P Isbister, Mandy Oade Jones, Gavin M Joynt, James A Judson, Richard T Keays, Warwick D Ngan Kee, Angus M Kennedy, Geoff Knight, Richard Leonard, Jeffrey Lipman, David P Mackie, Neil T Matthews, Colin McArthur, Angela McLuckie, Fiona Herris Moffatt, Cliff J Morgan, Thomas John Morgan, Peter T Morley, Raymond G Morris, Blair Munford, John A Myburgh, Michael Mythen, Matthew T Naughton, Alistair D Nichol, Helen Ingrid Opdam, Simon P G Padley, Mark Palazzo, Marcus Peck, Michael E Pelly, David V Pilcher, Didier Pittet, Brad Power, Raymond F Raper, Bernard Riley, John E Sanderson, Hugo Sax, Frank A Shann, Ramachandran Sivakumar, Elizabeth Sizer, George A Skowronski, Anthony J Slater, Martin Smith, Neil Soni, Stephen J Streat, David J Sturgess, Joseph J Y Sung, Ian K S Tan, Chris Theaker, James Tibballs, David Treacher, David V Tuxen, Richard N Upton, Balasubramanian Venkatesh, Adrian T J Wagstaff, Carl S Waldmann, John R Welch, Julia Wendon, Steve Wesselingh, Ubbo F Wiersema, Duncan LA Wyncoll, and Steve M Yentis

Published
2009
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5. Low cefpirome levels during twice daily dosing in critically ill septic patients: pharmacokinetic modelling calls for more frequent dosing

Author

David Fraenkel, Jeffrey Lipman, Steven C. Wallis, and Claire M. Rickard

Subjects
Adult, Male, Critical Illness, Renal function, Critical Care and Intensive Care Medicine, Bolus (medicine), Pharmacokinetics, Sepsis, Medicine, Humans, Dosing, Prospective Studies, Infusions, Intravenous, Antibacterial agent, APACHE, Aged, business.industry, Cefpirome, Middle Aged, Cephalosporins, Intensive Care Units, Treatment Outcome, Anesthesia, Pharmacodynamics, Area Under Curve, Trough level, Female, business, medicine.drug, Half-Life
Abstract

Objectives: To measure plasma levels and pharmacokinetics of cefpirome in critically ill septic patients with normal renal function. To use the pharmacokinetic model to simulate alternate dosing regimens and identify those that predict sustained levels. Design and setting: A prospective, open-label, descriptive study in a 22-bed, multidisciplinary, adult ICU in a university-affiliated, tertiary referral hospital. Patients: Twelve adults with normal renal function on enrolment and with suspected or documented sepsis in whom cefpirome was judged to be the appropriate therapy by the managing clinician. Interventions: Cefpirome 2 g was infused intravenously over 3 min every 12 h. Timed blood samples were taken prior to and during two dosing intervals. Urine was collected for creatinine clearance determination. Measurements and results: Two patients were non-evaluable due to renal dysfunction post-enrolment. The median cefpirome trough level was 1.1 mg/l (range 0.5–8.1 mg/l) after the initial dose and 1.4 mg/l (range

Published
2001

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