Skip to main content
Log in

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

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Raad II, Bodey GP (1992) Infection complications of indwelling vascular catheters. Clin Infect Dis 15:197–208

    CAS  PubMed  Google Scholar 

  2. Pittet D, Tamara D, Wenzel RP (1994) Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra cost and attributable mortality. JAMA 271:1598–1601

    CAS  PubMed  Google Scholar 

  3. Elliott TSJ (1997) Catheter-associated infections: new developments in prevention. In: Buchard H (ed) Current topics in intensive care. Saunders, London, pp 182–205

  4. Vincent JL, Bihari DJ, Suter PM et al. (1995) The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) study. JAMA 274:639–644

    CAS  PubMed  Google Scholar 

  5. National Nosocomial Infections Surveillance (NNIS) System Report (2001) Data summary from January 1992–June 2001. Am J Infect Control 29:404–421

    Article  PubMed  Google Scholar 

  6. Bjornson H, Colley R, Bower RH, Duty VP, Schwartz-Fulton JT, Fischer JE (1982) Association between microorganism growth at the catheter insertion site and colonization of the catheter in patients receiving total parenteral nutrition. Surgery 92:720–727

    PubMed  Google Scholar 

  7. Bach A, Eberhardt H, Frick A, Schmidt H, Böttiger B, Martin E (1999) Efficacy of silver-coating central venous catheters in reducing bacterial colonization. Crit Care Med 27:515–521

    Article  CAS  PubMed  Google Scholar 

  8. Elliott TS, Most HA, Tebbs SE, Wilson IC, Bonser RS, Graham TR, Burker LP, Faroqui MH (1997) Novel approach to investigate a source of microbial contamination of central venous catheters. Eur J Clin Microbiol Infect Dis 16:210–213

    CAS  PubMed  Google Scholar 

  9. Raad II, Baba M, Bodey GP (1995) Diagnosis of catheter-related infections: the role of surveillance and targeted quantitative skin cultures. Clin Infect Dis 20:593–597

    CAS  PubMed  Google Scholar 

  10. Raad I (1993) Intravascular catheter-related infections. Lancet 351:893–898

    Article  Google Scholar 

  11. Linares J, Sitges-Serra A, Garau J, Perez L, Martin R (1985) Pathogenesis of catheter sepsis: a prospective study with quantitative and semiquantitative cultures of catheter hub and segments. J Clin Microbiol 21:357–360

    CAS  PubMed  Google Scholar 

  12. Raad I, Costerton W, Sabharwal U, Sacilowski M, Anaissie E, Bodey GP (1993) Ultrastructural analysis of indwelling vascular catheters: a quantitative relationship between luminal colonization and duration of placement. J Infect Dis 168:400–406

    CAS  PubMed  Google Scholar 

  13. Maki DG, Mermel LA (1998) Infections due to infusion therapy. In: Bennett JS, Brachman PS (eds) Hopital infections. Lippincott-Raven, Philadelphia, pp 689–724

  14. Henderson DK (2000) Infections due to percuataneous intravascular devices. In: Mandel GL, Bennett JE, Dolin R (eds) Mandell, Douglas and Bennetts principles and practice of infectious diseases.Churchill Livingstone, New York, pp 3005–3015

  15. Appelgren P, Ransjo U, Bindslev L, Espersen F, Larm O (1996) Surface heparinization of central catheters reduce microbial colonization in vitro and in vivo. Results from a prospective, randomized trial. Crit Care Med 24:1482–1489

    Article  CAS  PubMed  Google Scholar 

  16. Mermel LA, Stolz SM, Maki DG (1993) Surface antimicrobial activity of heparin-bonded and antiseptic-impregnated vascular catheters. J Infect Dis 167:920–924

    CAS  PubMed  Google Scholar 

  17. Darouiche RO, Raad II (1997) Prevention of catheter-related infection: the skin. Nutrition 13 [Suppl 4]:26–29S

  18. Modak SM, Sampath L (1992) Development and evaluation of a new polyurethane central venous antisepstic catheter. Complications Surg 11:23–29

    Google Scholar 

  19. Pemberton Beaty L, Ross V, Cuddy P, Kremer H, Fessler T, McGurk E (1996) No difference in catheter sepsis between standard and antiseptic central venous catheters. Arch Surg 131:986–989

    CAS  PubMed  Google Scholar 

  20. Ciresi DL, Albrecht RM, Volkers PA, Scholten DJ (1996) Failure of antiseptic bonding to prevent central venous catheter-related infection and central sepsis. Am Surg 62:641–646

    CAS  PubMed  Google Scholar 

  21. Logghe C, Van Ossel C, Dhoore W, Ezzedine H, Wauters G, Haxhe JJ (1997) Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukemic patients: a randomized controlled trial. J Hosp Infect 37:145–156

    CAS  PubMed  Google Scholar 

  22. Loo S, Heerden PV van, Gollege CL, Roberts BL, Power BM (1997) Infection in central lines: antiseptic-impregnated catheter vs standard non-impregnated catheters. Anaesth Intensive Care 25:637–639

    CAS  PubMed  Google Scholar 

  23. Heard SO, Wagle M, Vijayakumar E et al. (1998) Influence of triple lumen central venous catheter coated with chlorhexidine and silver sulfadiazine on the incidence of catheter-related bacteremia. Arch Intern Med 158:81–87

    CAS  PubMed  Google Scholar 

  24. Hanley EM, Veeder A, Smith T, Drusano G, Currie E, Venezia RA (2000) Evaluation of an antiseptic triple-lumen catheter in an intensive care unit. Crit Care Med 28:366–370

    Article  CAS  PubMed  Google Scholar 

  25. Maki DG, Stolz SM, Wheeler S, Mermel LA (1997) Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial. Ann Intern Med 127:257–266

    CAS  PubMed  Google Scholar 

  26. Hannan M, Juste RN, Umasanker S, Glendenning A, Nightingale C, Azadian B, Soni N (1999) Antiseptic-bonded central venous catheters and bacterial colonisation. Anaesthesia 54:868–872

    CAS  PubMed  Google Scholar 

  27. Collin RG (1999) Decreasing catheter colonization through the use of antiseptic-impregnated catheter. Chest 115:1632–1640

    CAS  PubMed  Google Scholar 

  28. Sheng W-H, Ko W-J, Wang J-T, Chang S-C, Hsueh P-R, Luh K-T (2000) Evaluation of antiseptic-impregnated central venous catheters for prevention of catheter-related infection in intensive care patients. Diagn Microbiol Infect Dis 38:1–5

    Article  CAS  PubMed  Google Scholar 

  29. Maki DG, Weise CE, Sarafin HW (1977) A semiquantitative culture method for identifying intravenous catheter-related infections. N Engl J Med 296:1305–1309

    CAS  PubMed  Google Scholar 

  30. Brun-Bruisson C, Abrouk F, Legrand P, Huet S, Rapin M (1987) Diagnosis of central venous catheters-related sepsis: critical level of quantitative tip cultures. Arch Intern Med 147:873–877

    CAS  PubMed  Google Scholar 

  31. Carrasco MN, Nogueira R, Cobo N, De Miguel E, Garcia N, De Las Cuevas C, Ruiz-Ocaña F (1998) Central venous catheters. Evaluating the clinical suspicion of infection. Abstract K-20. ICAAC, San Diego

  32. Sitges-Serra A, Liñares J (1988) Limitations of semiquantitative method for catheter culture. J Clin Microbiol 26:1074–1075

    CAS  PubMed  Google Scholar 

  33. Yorganci K, Krepel C, Weigelt JA, Edmiston CE (2002) In vitro evaluation of the antibacterial activity of three different central venous catheters against gram-positive bacteria. Eur J Clin Microbiol Infect Dis 21:379–384

    Article  CAS  PubMed  Google Scholar 

  34. Yorganci K, Krepel C, Weigelt JA, Edmiston CE (2002) Activity of antibacterial impregnated central venous catheter against Klebsiella pneumoniae. Intensive Care Med 28:438–442

    Article  Google Scholar 

  35. Schmitt SK, Knapp C, Hall GS, Longworth DL, McMahon JT, Washington JA (1996) Impact of chlorhexidine-silver sulfadiazine impregnated central venous catheters on in vitro quantitation of catheter associated bacteria. J Clin Microbiol 34:508–511

    CAS  PubMed  Google Scholar 

  36. Sheretz RJ, Ely EW, Westbrook DM et al. (2000) Education of physicians-in-training can decrease the risk for vascular catheter infection. Ann Intern Med 132:641–648

    Google Scholar 

  37. Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D (2000) Impact of prevention strategy targeted at vascular-access care on incidence of infection acquired in intensive care. Lancet 355:1864–1868

    CAS  PubMed  Google Scholar 

  38. Krafte-Jacobs B, Sivit CJ, Mejia R, Pollack MM (1995). Catheter-related thrombosis in critically ill children: comparison of catheters with and without heparin bonding. J Pediatr 126:50–54

    CAS  PubMed  Google Scholar 

  39. Pierce CM, Wade A, Mock Q (2000) Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med 26:967–972

    Article  CAS  PubMed  Google Scholar 

  40. Eiff C von, Proctor RA, Peters G (2001) Coagulase-negative staphylococci pathogens have a major role in nosocomial infections. Post Grad Med 110:4

    Google Scholar 

  41. Mermel LA (2001) New technologies to prevent intravascular catheter-related bloodstream infections. Emerg Infect Dis 7:197–199

    CAS  PubMed  Google Scholar 

Download references

Acknowledgements

We thank Francisco J.Rodriguez MD, for assistance with statistical analysis and the nurses of the ICU and Microbiology departments for their support.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. N. Carrasco.

Additional information

Presented in part as an abstract (K-1426) at the 41st Annual ICAAC, Chicago, December 2001.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carrasco, M.N., Bueno, A., de las Cuevas, C. et al. Evaluation of a triple-lumen central venous heparin-coated catheter versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients. Intensive Care Med 30, 633–638 (2004). https://doi.org/10.1007/s00134-003-2093-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-003-2093-4

Keywords

Navigation