A prospective randomized trial of rifampicin-minocycline coated and silver-platinum-carbon impregnated central venous catheters

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Title A prospective randomized trial of rifampicin-minocycline coated and silver-platinum-carbon impregnated central venous catheters
Author Fraenkel, David; Rickard, Claire; Thomas, Peter; Faoagali, Joan; George, Narelle; Ware, Robert
Journal Name Critical Care Medicine
Year Published 2006
Place of publication USA
Publisher Lippincott Wilkins & Williams
Abstract OBJECTIVE: Central venous catheters are the predominant cause of nosocomial bacteremia; however, the effectiveness of different antimicrobial central venous catheters remains uncertain. We compared the infection rate of silver-platinum-carbon (SPC)-impregnated catheters with rifampicin-minocycline (RM)-coated catheters. DESIGN: A large, single-center, prospective randomized study. SETTING: Twenty-two-bed adult general intensive care unit in a large tertiary metropolitan hospital in Brisbane, Australia (2000-2001). PATIENTS: Consecutive series of all central venous catheterizations in intensive care unit patients. INTERVENTIONS: Randomization, concealment, and blinding were carefully performed. Catheter insertion and care were performed according to published guidelines. Blood cultures were taken at central venous catheter removal, and catheter-tip cultures were performed by both roll-plate and sonication techniques. Pulsed field gel electrophoresis was used to establish shared clonal origin for matched isolates. MEASUREMENTS AND MAIN RESULTS: Central venous catheter colonization and catheter-related bloodstream infection were determined with a blinded technique using the evaluation of the extensive microbiological and clinical data collected and a rigorous classification system. Six hundred forty-six central venous catheters (RM 319, SPC 327) were inserted, and 574 (89%) were microbiologically evaluable. Colonization rates were lower for the RM catheters than SPC catheters (25 of 280, 8.9%; 43 of 294, 14.6%; p=.039). A Kaplan-Meier analysis that included catheter time in situ did not quite achieve statistical significance (p=.055). Catheter-related bloodstream infection was infrequent for both catheter-types (RM 4, 1.4%; SPC 5, 1.7%). CONCLUSIONS: The SPC catheter is a clinically effective antimicrobial catheter; however, the RM catheter had a lower colonization rate. Both catheter types had low rates of catheter-related bloodstream infection. These results indicate that future studies will require similar rigorous methodology and thousands of central venous catheters to demonstrate differences in catheter-related bloodstream infection rates.
Peer Reviewed Yes
Published Yes
Publisher URI http://www.ccmjournal.org/pt/re/ccm/home.htm;jsessionid=HcfB2x2dY5dhlGyrJzGL12r2bdSTs51cKZBcnJS6Lp6668MTnGY7!1071114923!181195629!8091!-1
Copyright Statement Copyright 2006 Lippincott, Williams & Wilkins. Self-archiving of the author-manuscript version is not yet supported by this publisher. Please use the hypertext link above to access the journal's website or contact the author for more information.
Volume 34
Issue Number 3
Page from 668
Page to 675
ISSN 0090-3493
Date Accessioned 2007-05-10
Language en_AU
Research Centre Centre for Health Practice Innovation; Menzies Health Institute Qld
Faculty Griffith Health Faculty
Subject Clinical Nursing: Secondary (Acute Care); Intensive Care
URI http://hdl.handle.net/10072/15306
Publication Type Journal Articles (Refereed Article)
Publication Type Code c1x

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