Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients

Byline: M. N. Carrasco (1), A. Bueno (1), C. Cuevas (2), S. Jimenez (2), I. Salinas (1), A. Sartorius (1), T. Recio (1), M. Generelo (1), F. Ruiz-Ocana (1) Keywords: Catheter-related blood infection; Catheter colonization; Central venous catheter; Intensive care unit; Antiseptic catheter; Heparin catheter Abstract: 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. Author Affiliation: (1) Intensive Care Unit, Hospital Universitario de la Princesa, Diego de Leon 62, 28006, Madrid, Spain (2) Department of Microbiology, Hospital Universitario de la Princesa, Diego de Leon 62, 28006, Madrid, Spain Article History: Registration Date: 06/11/2003 Received Date: 04/02/2003 Accepted Date: 31/10/2003 Online Date: 13/01/2004 Article note: Presented in part as an abstract (K-1426) at the 41st Annual ICAAC, Chicago, December 2001.