Comparison of antimicrobial impregnation with tunneling of long-term central venous catheters: A randomized controlled trial

Rabih O. Darouiche, David H. Berger, Nancy Khardori, Claudia S. Robertson, Matthew J. Wall, Michael H. Metzler, Seema Shah, Mohammad D. Mansouri, Colleen Cerra-Stewart, James Versalovic, Michael J. Reardon, Issam I. Raad

Research output: Contribution to journalArticlepeer-review

97 Scopus citations

Abstract

Objective: We sought to compare the impact of antimicrobial impregnation to that of tunneling of long-term central venous catheters on the rates of catheter colonization and catheter-related bloodstream infection. Summary Background Data: Tunneling of catheters constitutes a standard of care for preventing infections associated with long-term vascular access. Although antimicrobial coating of short-term central venous catheters has been demonstrated to protect against catheter-related bloodstream infection, the applicability of this preventive approach to long-term vascular access has not been established. Methods: A prospective, randomized clinical trial in 7 university-affiliated hospitals of adult patients who required a vascular access for ≥2 weeks. Patients were randomized to receive a silicone central venous catheter that was either impregnated with minocycline and rifampin or tunneled. The occurrence of catheter colonization and catheter-related bloodstream infection was determined. Results: Of a total of 351 inserted catheters, 346 (186 antimicrobial-impregnated and 160 tunneled) were analyzed for catheter-related bloodstream infection. Clinical characteristics were comparable in the 2 study groups, but the antimicrobial-impregnated catheters remained in place for a shorter period of time (mean, 30.2 versus 43.8 days). Antimicrobial-impregnated catheters were as likely to be colonized as tunneled catheters (7.9 versus 6.3 per 1000 catheter-days). Bloodstream infection was 4 times less likely to originate from antimicrobial-impregnated than from tunneled catheters (0.36 versus 1.43 per 1000 catheter-days). Conclusions: Antimicrobial impregnation of long-term central venous catheters may help obviate the need for tunneling of catheters.

Original languageEnglish (US)
Pages (from-to)193-200
Number of pages8
JournalAnnals of surgery
Volume242
Issue number2
DOIs
StatePublished - Aug 2005

ASJC Scopus subject areas

  • Surgery

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