Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter–related infections: a prospective, randomized study

doi:10.1016/S0002-9343(03)00367-X

The American Journal of Medicine

Volume 115, Issue 5, 1 October 2003, Pages 352-357

https://doi.org/10.1016/S0002-9343(03)00367-X Get rights and content

Abstract

Purpose

To determine the efficacy of minocycline-rifampin–coated hemodialysis catheters in reducing catheter-related infections in patients requiring hemodialysis for acute renal failure.

Methods

Between May 2000 and March 2002, 66 patients were randomly assigned to receive a minocycline-rifampin–impregnated central venous catheter and 64 were randomly assigned to receive an unimpregnated catheter. Patients were followed prospectively until the catheter was removed. Catheter-related infection was determined through quantitative catheter cultures, quantitative blood cultures, or both.

Results

Both groups of patients were similar in age, sex, underlying disease, type of dialysis (continuous vs. intermittent), neutropenia during catheterization and its duration, catheter insertion difficulties, and administration of blood products or medication. The mean (± SD) catheter dwell time was the same in both groups (8 ± 6 days, P = 0.7). There were seven catheter-related infections (11%), all associated with the use of unimpregnated catheters. Kaplan-Meier estimates for the risk of catheter-related infection showed that coated catheters were less likely to be associated with infection (P = 0.006).

Conclusion

The use of polyurethane hemodialysis catheters impregnated with minocycline and rifampin decreases the risk of catheter-related infection in patients with acute renal failure.

Section snippets

Subjects

The study was conducted between May 2000 and March 2002 at The University of Texas M. D. Anderson Cancer Center. All hospitalized adult cancer patients who required hemodialysis through a central venous catheter for more than 3 days and up to 1 month were eligible. We excluded patients who required an exchange of the catheter over guidewire, rather than a new insertion, and those who were allergic to rifampin and tetracyclines. The Institutional Review Board approved the study. All enrolled

Results

A total of 140 patients consented to participate in the study. There were nine unsuccessful insertion attempts (5 coated with minocycline and rifampin, 4 uncoated controls), and 1 patient died before an insertion attempt, leaving 130 patients who each received one hemodialysis catheter (66 coated, 64 control). All patients were followed until the catheter was removed. The two groups were similar in age, sex, underlying disease, continuous versus intermittent dialysis, admission to the intensive

Discussion

Although hemodialysis catheters are the leading source of bloodstream infections in hemodialysis patients (20), our study showed that noncuffed, femoral central venous catheters that were coated with minocycline and rifampin decreased the risk of catheter-related infections by at least sevenfold in patients undergoing short-term hemodialysis. Indeed, minocycline-rifampin–coated central venous catheters have been shown to be effective in preventing catheter-related infections in nondialysis,

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^☆: This study was supported in part by a grant from Cook Critical Care, Bloomington, Indiana. The design and conduct of the study; the collection, analysis, and interpretation of the data; as well as the preparation, review, and approval of the manuscript were done independently from the sponsoring company.

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Clinical studyAntibiotic-coated hemodialysis catheters for the prevention of vascular catheter–related infections: a prospective, randomized study☆

Abstract

Purpose

Methods

Results

Conclusion

Section snippets

Subjects

Results

Discussion

Lancet

Am J Kidney Dis

Kidney Int

Kidney Int

Diagn Microbiol Infect Dis

Am J Infect Control

Kidney Int

Lancet

Am J Kidney Dis

Antimicrob Agents Chemother

1994 Annual Data Report

Combined report on dialysis and transplantation in Europe

Proc Eur Dial Transplant Assoc

Incidence and type infections occurring in 445 chronic hemodialysis patients

Trans Am Soc Artif Intern Organs

Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections

Ann Intern Med

A comparison of two antimicrobial-impregnated central venous catheters

N Engl Med

Clinical study
Antibiotic-coated hemodialysis catheters for the prevention of vascular catheter–related infections: a prospective, randomized study☆