Prevention of catheter related bloodstream infection by silver iontophoretic central venous catheters: a randomised controlled trial

Abstract

Aim: To evaluate the efficacy of silver iontophoretic central venous catheters in preventing catheter related colonisation and bloodstream infection among high risk patients in a tertiary hospital. Methods: Patients requiring central venous access for a period greater than seven days were stratified into two groups according to systemic inflammatory response syndrome criteria before being randomly assigned to receive either silver iontophoretic or control catheters. The incidence of catheter colonisation and catheter related bloodstream infection (CRBSI) was recorded. Results: Three hundred and four single lumen study catheters were inserted into 268 patients. Total duration of catheterisation was 5449 days (median, 12 days/catheter). Complete data could be evaluated in 270 catheters: 128 silver iontophoretic catheters and 140 untreated catheters. Forty seven silver iontophoretic catheters (36.7%) were colonised compared with 48 control catheters (33.8%). Seven cases (5.5%) of CRBSI occurred in patients who received silver iontophoretic catheters, compared with 11 cases (7.7%) in patients receiving control catheters. There was no significant difference in the incidence of catheter colonisation or CRBSI between silver iontophoretic and control catheters. When the duration of catheter placement was taken into consideration, Kaplan-Meier analysis showed no significant difference in the risk of CRBSI between the silver iontophoretic catheters and the untreated catheters (p = 0.77). Conclusion: There was no significant difference in the incidence of catheter colonisation or CRBSI among high risk patients between silver iontophoretic catheters and control catheters. Future prospective, randomised studies with a larger number of catheters are encouraged to confirm or refute these results.

The clinical effectiveness and cost-effectiveness of central venous catheters treated with anti-infective agents in preventing bloodstream infections: a systematic review and economic evaluation

“…No estimates of the intracluster correlation coefficient were available, and given the robustness of the results in the sensitivity analysis this was not pursued further. 16 Boswald, 1999, 66 Raad, 1997 38 and Stoiser, 2002;69 all other trials reported mean duration.…”

“…The three trials not reporting the number of patients analysed included a total of 737 CVCs (n = 270, 235 and 232). 16,64,65 Therefore, the number of patients analysed was in the range of 6634-7371.…”

“…The majority of trials reported mean duration, although four trials were included that reported median duration. 16,38,66,69 It is likely that the data are skewed and means would overestimate the average length of time for which the catheters were inserted.…”

“…By July 2005 a further 11 trials had been published. [8][9][10][11][12][13][14][15][16][17][18] This review was commissioned to determine the clinical effectiveness and cost-effectiveness of CVCs treated with anti-infective agents (AI-CVCs).…”

Antimicrobial activity and cytocompatibility of silver nanoparticles coated catheters via a biomimetic surface functionalization strategy

“…4 Silver is widely exploited because of its good antimicrobial action to a wide range of microorganisms. 5,6 In the meantime, silver nanoparticles (AgNPs), as a novel form, are applied in a number of products such as medical device and implant coatings. The catheters can be coated internally and externally with silver containing compounds or impregnated with silver.…”