Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia

Abstract

A prospective, randomized, controlled, multi-centre clinical trial was performed to test the effectiveness of an antimicrobial central venous catheter (CVC) made of polyurethane integrated with silver, platinum and carbon black (Vantex). Adults expected to require a CVC for more than 60 h were eligible, and were randomized to receive the test or control catheter. All CVCs were inserted with new venipunctures using full aseptic technique. Following catheter removal, the distal tip and an intracutaneous segment were removed and cultured using semiquantitative and quantitative methods. Peripheral blood samples were obtained and cultured to confirm cases of catheter-related bloodstream infection (CRBSI). Bacterial and fungal organisms were identified by standard microbiological methods. Catheter placement was performed primarily in the intensive care unit (50%) or operating theatre (42%). Complete data could be evaluated for 539 patients (77%). The mean duration of CVC placement was 149.3h (six days). There were no significant differences in colonization or bacteraemia rates between the test and control catheters. The overall colonization rate was not particularly low (24.5%), and yet CVC-related bacteraemia occurred in only 1.4% of patients, and CRBSI occurred in only one patient from the control group (0.2%). Insertion site and dressing change frequency were significantly associated with the colonization rate. Although CVCs with antimicrobial features have been associated with a decrease in catheter-related colonization and bacteraemia, this study demonstrated that infection rates may depend more on non-catheter-related factors, such as adherence to infection control standards, selection of insertion site, duration of CVC placement, and dressing change frequency. As microbial resistance increases, clinicians should make maximal use of these processes to reduce catheter-related infections.

An Interventional Study to Decrease Central Venous Catheter Related Blood Stream Infection in Intensive Care Units at Zagazig University Hospital

“…These findings were similar to that reported by Longmate et al (26) and CherryBukowiec et al (27) . Z.U.M.J.Vol.19; N.6; November; 2013 -503-…”

The effect of silver-impregnated catheters on catheter colonization and catheter-related bloodstream infection: a comparison between silver-impregnated and standard catheter

“…The authors explained that the rate of infection may depend on non-catheter related factors, for instance, site of insertion, the frequency of dressing change, and the adherence to infection control measures. 16 While in another study by Fraenkel D et al the authors concluded that SPC catheters have a low colonization rate, but are not effective as rifampicin-minocycline-coated (RM) catheters (14.6% vs. 8.9% P=0.39) for SPC catheters and RM catheters respectively. But fortunately, both types had low rates of CRBSI.…”

“…20 The previously mentioned RCTs had several limitations that can be summarized in the following Table 2. 16 -The study was performed in single hospital and had a small sample size -Only the external surface of the catheter was evaluated for colonization Camargo et al 18 The study was only blinded for the microbiologist and the expert team who performed the judgment of CRBSI. Kalfon et al 19 -Unblended randomized control study -Single study setting Hagau et al 20 Despite the clinical effectiveness of silver-impregnated central venous catheters across the literature, some randomized trials suggest that the role of silverimpregnated CVCs in reducing the catheter colonization and catheter-related bloodstream infection is limited and considered as a controversial issue in clinical practice, especially, with the new development of different types of CVCs and the diversity of manufacturing materials that are being used as additives to improve the CVCs' effectiveness.…”

Universal Precautions in Preventing Central Venous Catheter Associated Blood Stream Infections. A Study at Tertiary Care Hospital of ‘Central Line Bundles’ in MICU

“…Another study has also demonstrated an increase in BSI rates in patients who used multiple-lumen catheters (Moretti et al, 2005).…”