Reducing catheter-associated infections with silver-impregnated catheters in long-term therapy of children

Central venous long-term catheters offer reliable, large-lumen vascular acc ess with high flow rates for delivery of nutrition or for cell-containing i nfusions and perfusions, Catheter-associated infections (CAI) pose the grea test threat to such vascular access, despite existing preventive measures. In this article one prospective and one retrospective study of CAI in pedia tric therapy are presented. Study I: A retrospective investigation from 199 0 through 1995 of 60 conventional long-term catheters in 50 patients. The t otal number of days in which the catheters were in place was 11,818, The ca lculated CAI incidence was 1 per 1,000 days of catheter insertion. Bacterio logically demonstrated CAI (identical isolate on the catheter tip and in a blood culture) occurred in three instances (5%), Five cases (8.3%) were dia gnosed with a therapy-resistant, septic clinical picture. Study II: A prosp ective, randomized comparison of long-term silver-impregnated (Erlanger sil ver catheters) and control catheters (Quinton(R) Instrument Co.) was made w ith 41 patients (20 with a silver catheter, 21,vith a Quinton(R) catheter), To date, the silver catheters have been distinguished by sterile bacteriol ogical findings, whereas three cases of CAI have been demonstrated with the comparative catheters, One patient recently underwent intensive care after becoming unstable with signs of septic shock and demonstrable Pseudomonas aeruginosa, and two other patients manifested coagulase-negative staphyloco cci on the catheter tips. In three of nine control catheters an incidence o f 1.18 per 1,000 days of indwelling catheters was found, whereas no CAI has occurred with the eight microbiologically tested silver catheters.