Reducing catheter-associated infections with silver-impregnated catheters in long-term therapy of children

Abstract

Central venous long-term catheters offer reliable, large-lumen vascular access with high flow rates for delivery of nutrition or for cell-containing infusions and perfusions. Catheter-associated infections (CAI) pose the greatest threat to such vascular access, despite existing preventive measures. In this article one prospective and one retrospective study of CAI in pediatric therapy are presented. Study I: A retrospective investigation from 1990 through 1995 of 60 conventional long-term catheters in 50 patients. The total number of days in which the catheters were in place was 11,818. The calculated CAI incidence was 1 per 1,000 days of catheter insertion. Bacteriologically demonstrated CAI (identical isolate on the catheter tip and in a blood culture) occurred in three instances (5%). Five cases (8.3%) were diagnosed with a therapy-resistant, septic clinical picture. Study II: A prospective, randomized comparison of long-term silver-impregnated (Erlanger silver catheters) and control catheters (Quinton Instrument Co.) was made with 41 patients (20 with a silver catheter, 21 with a Quinton catheter). To date, the silver catheters have been distinguished by sterile bacteriological findings, whereas three cases of CAI have been demonstrated with the comparative catheters. One patient recently underwent intensive care after becoming unstable with signs of septic shock and demonstrable Pseudomonas aeruginosa, and two other patients manifested coagulase-negative staphylococci on the catheter tips. In three of nine control catheters an incidence of 1.18 per 1,000 days of indwelling catheters was found, whereas no CAI has occurred with the eight microbiologically tested silver catheters.

Effect of microparticulate silver addition in dental adhesives on secondary caries in vitro

“…In general, pure silver additions have been previously reported to provide certain antibacterial properties for a variety of biomaterials such as bone cements, medical catheter materials, and finally resin composites for dental restorations [24,[38][39][40]. In medical devices, the omission of antibiotics is an interesting factor in favor of microparticulate silver additions, e.g., in catheters, and the clinical effectiveness has been clearly proven for many years [38][39][40].…”

A review and perspective of existing research on the release of nanomaterials from solid nanocomposites

“…Some nanocomposites are designed to come into direct contact with humans including, dental fillings [55], medical devices [100-102], and textiles [103,104]. Also, nanocomposites designed for vehicle exteriors have been examined for release in the context of collisions [105].…”

“…Although these state-of-the-art antimicrobial polymer catheters were presumed to release silver ions continuously [100-102]; Joyce-Wöhrmann et al [109] were the first to directly investigate release. In a brief communication, the authors report their observation that silver ions were released from thermoplastic polyurethane catheters with varying amounts of added silver-NP after a 24 hour incubation in physiological saline held at 37°C.…”

Proteomic analysis of the proteins released from Staphylococcus aureus following exposure to Ag(I)

“…Central venous catheters impregnated with silver metal particles substantially reduced the incidence of catheter-associated infections (CAIs) in paediatric patients (Carbon et al, 1999). Such silver-impregnated catheters have been shown to prevent CAIs through a reduction in bacterial adherence by up to 40% .…”