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Evaluation of a triple-lumen central venous catheter heparin-bonded versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients A randomized, clinical trial



Evaluation of a triple-lumen central venous catheter heparin-bonded versus a catheter coated with chlorhexidine and silver sulfadiazine in critically ill patients A randomized, clinical trial



Abstracts of the Interscience Conference on Antimicrobial Agents and Chemotherapy 41: 426



Objective: To compare the incidence of catheter colonization (CC) and catheter related bloodstream infection (CRBSI) between catheters heparin-bondeb (HB) and impregnated with chlorhexidine and silver sulfadiazine (CSS) on the outer surface. Methods: 194 adults patients admitted to a surgical-medical intensive care unit and needing a triple-lumen central venous catheter were randomized to received either a catheter HB or CSS. Catheter removal was made by independent physician. All catheters were removed aseptically and the 5-cms distal segment were cultured and two blood cultures were taken percutaneus. CC was defined by gtoreq15 cfu semiquantitative, and quantitative by gtoreq1000 cfu/ml. CRBSI as isolation of the same organism from blood culture and catheter. Data collected for each catheter included patient's diagnoses, APACHE II, reasons for removal, parenteral nutrition, insertion sites, duration of catheterization, antibiotic therapy and additional site of infection. Results: HB group 132 catheters, CC was detected in 29 (23 gram-positive bacteria, 7 gram-negative bacilli and 4 candida sp). Rates of CC were 23.5/1000 catheters-days and CRBSI 3.24/1000 catheters-days. CSS group 128 catheter, CC were in 13(6 gram-posive bacteria, 11 gram-negative bacilli). Rates of CC 13.3/1000 catheters-days and CRBSI 2.6/1000 catheters-days. In CC the median duration was 9 and 9.5 days and Apache II 20 and 22 respectively Statistical analysis:CC, P=.03, RR=2.16 (1.18-3.97). Rate of CC/1000 catheters-days P=0.03, RR=0.49 (0.26-0.94). The CC by microorganism isolate P=0.0098. Rate of CRBSI/1000 catheters-days P=0.79, RR=1.22 (0.27-5.43). Conclusions: The use of CSS reduces the risk of catheter colonization. This effect was related to a more efficacious prevention of gram-positive bacteria and candida sp. But CRBSI was similar for the two groups.

Accession: 034879683

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