A PROSPECTIVE RANDOMIZED TRIAL OF AN ANTIBIOTIC-COATED AND ANTISEPTIC-COATED CENTRAL VENOUS CATHETER IN THE PREVENTION OF CATHETER-RELATED INFECTIONS

Objective: To test the efficacy of the ARROWgard (Arrow International Inc, Reading, Pa) central venous catheter (CVC) coated with silver sul fadiazine and chlorhexidine (A-CVC) in the prevention of CVC-related i nfections. Design: Prospective, randomized trial. Setting: A tertiary care medical center. Patients and Intervention: Two hundred eighty-two patients who required CVC placement were evaluated in this study. Pat ients were prospectively randomized to receive either a standard CVC ( S-CVC) or the A-CVC. Only fresh-stick double-and triple-lumen catheter s were studied. Main Outcome Measures: Patients were evaluated for cat heter site inflammation, catheter site colonization, local catheter-re lated infection, and catheter-related septicemia. Results: The 2 group s were matched for age, percentage in the intensive care unit, percent age receiving total parenteral nutrition, percentage with triple-lumen catheters, and duration of catheterization. Rates of catheter site in flammation in the 2 groups were similar (12% vs 10%, S-CVC group and A -CVC group, respectively). The A-CVC was associated with a significant ly decreased catheter site colonization rate (49% vs 28%; 43% reductio n; P<.001) and local catheter-related infection rate (22.4% vs 5.8%; 7 4% reduction; P<.001). Rates of catheter-related septicemia were reduc ed by 41% in the A-CVC group (6.4% vs 3.8%, S-CVC group and A-CVC grou p, respectively), but this was not statistically significant, Conclusi ons: Despite a marked decrease in catheter site colonization and cathe ter-related infection rates, the A-CVC did not significantly reduce th e incidence of catheter-related septicemia. This may be due to a great er pathogenic dependence on catheter hub contamination rather than cat heter site colonization or local catheter-related infection, or the re latively short (5.2 days) duration of catheterization in this study.