INFLUENCE OF TRIPLE-LUMEN CENTRAL VENOUS CATHETERS COATED WITH CHLORHEXIDINE AND SILVER SULFADIAZINE ON THE INCIDENCE OF CATHETER-RELATED BACTEREMIA

Objective: To evaluate the efficacy of triple-lumen central venous cat heters coated with a combination product of chlorhexidine and silver s ulfadiazine (CSS) in reducing the incidence of local catheter infectio n and catheter-related bacteremia. Design: Randomized, controlled tria l. Setting: The surgical intensive care units in a university hospital . Patients: All patients who needed central venous catheterization wer e randomized to receive either an uncoated triple-lumen catheter (n = 157) or a catheter coated with CSS (n = 151). Main Outcome Measure: Ca theters were removed when no longer needed or suspected as a cause of infection. The tip and a 5-cm segment of the intradermal portion of th e catheter were cultured semiquantitatively. Blood cultures were obtai ned when clinically indicated. The remaining segment of catheters coat ed with CSS were cut and incubated on an agar plate with strains of St aphylococcus aureus and Enterococcus. Zone of inhibition was determine d 24 hours later. Data were analyzed by survival and logistic multivar iate regression methods. Results: Catheters coated with CSS were effec tive in reducing the rate of significant bacterial growth on either th e tip or intradermal segment (40%) compared with control catheters (52 %; P = .04). However, there was no difference in the incidence of cath eter-related bacteremia (3.8% [uncoated] vs 3.3% [coated]; P = .81). I n vitro activity of catheters with CSS against S aureus was evident up to 25 days but activity against Enterococcus dissipated more quickly over time and was absent by day 4. The most common colonizing organism s were coagulase-negative staphylococcus and enterococcus. Variables t hat were associated with a significant amount of growth on the tip or intradermal segment were a duration of catheterization of longer than 7 days, jugular insertion site, and the absence of a CSS coating. The use of a guidewire when the catheter was removed was associated with a lower risk of significant bacterial growth. Conclusions: The use of C SS reduces the incidence of significant bacterial growth on either the tip or intradermal segments of coated triple-lumen catheters but has no effect on the incidence of catheter-related bacteremia. In this pat ient population, catheters coated with CSS provide no additional benef it over uncoated catheters.