Intravascular catheters impregnated with antimicrobial agents: a milestonein the prevention of bloodstream infections

Vascular catheters impregnated with antimicrobial agents have been shown to decrease the risk of catheter-related colonization and bloodstream infecti ons. Various antimicrobials and antiseptics have been used. In a recent met a-analysis of 12 studies, catheters coated with chlorhexidine and silver su lfadiazine (CH/SS) were shown to be significantly less likely to be associa ted with catheter-related bloodstream infections than uncoated catheters. H owever, these catheters were coated only on the external surface and they a re associated with short antimicrobial durability (3-7 days). In addition, anaphylactic reactions to them were reported in Japan. Vascular catheters i mpregnated with minocycline and rifampin (M/R) were found to be highly effi cacious in preventing catheter-related infections. In a recent prospective, randomized trial, the likelihood of catheter-related bloodstream infection s associated with the use of M/R catheters was one-twelfth of that observed with catheters coated with CH/SS. The M/R catheters are coated on the exte rnal and internal surfaces and have an antimicrobial durability of 4 weeks. Although no resistance to either minocycline or rifampin has been seen in two trials, further studies are required to determine whether the risk of r esistance outweighs the benefits derived from their use. In conclusion, ant imicrobial catheters have been shown to be highly cost effective in decreas ing the risk of catheter-related bloodstream infection.