Subclavian Hemodialysis Catheter Infections: A Prospective, Randomized Trial of an Attachable Silver-Impregnated Cuff for Prevention of Catheter-Related Infections

Dahlberg, Philip J.; Agger, William A.; Singer, James R.; Yutuc, Wilfrido R.; Newcomer, Kermit L.; Schaper, Ana M.; Rooney, Brenda L.

doi:10.2307/30105091

Cited by 44 publications

(21 citation statements)

References 23 publications

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“…The positive results of these earlier studies made routine use of silver-coated megaprostheses possible in our department. Since negative results with silver-coated devices have also been reported in the literature [10,11,25], it was desirable to present early results with the new prosthesis in order to avoid potential errors. Schierholz et al [26] have raised concerns that free silver ions may precipitate in albumin-containing environments (e.g., hematoma), leading to concentrations that are too low for bactericidal effects to be achieved.…”

Section: Discussionmentioning

confidence: 99%

“…Toxicological side effects in patients receiving a silver-coated tumor endoprosthesis have been excluded in previous studies [9], and high antimicrobial activity of the silver coating has been demonstrated in a rabbit model [4]. However, a lack of effectiveness has also been reported [10,11]. The aim of the present study was therefore to compare the actual infection rate among patients with titanium tumor prostheses with the infection rate in patients in whom silver-coated prostheses were implanted in the proximal femur and proximal tibia.…”

Section: Introductionmentioning

confidence: 99%

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Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Hardes

Eiff

Streitbuerger

et al. 2010

Journal of Surgical Oncology

301

225

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Background and Objectives: The placement of megaprostheses in patients with bone sarcoma is associated with high rates of infection, despite prophylactic antibiotic administration. In individual cases, secondary amputation is unavoidable in the effort to cure infection. Methods: The infection rate in 51 patients with sarcoma (proximal femur, n ¼ 22; proximal tibia, n ¼ 29) who underwent placement of a silver-coated megaprosthesis was assessed prospectively over a 5-year period, along with the treatment administered for infection. The infection rate was compared with the data for 74 patients in whom an uncoated titanium megaprosthesis (proximal femur, n ¼ 33; proximal tibia, n ¼ 41) was implanted. Results: The infection rate was substantially reduced from 17.6% in the titanium to 5.9% in the silver group. Whereas 38.5% of patients in the titanium group ultimately had to undergo amputation when periprosthetic infection developed, these mutilating surgical procedures were not necessary in the study group. Conclusions: The use of silver-coated prostheses reduced the infection rate in the medium term. In addition, less aggressive treatment of infection was possible in the group with silver-coated prostheses. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Hardes

Eiff

Streitbuerger

et al. 2010

Journal of Surgical Oncology

301

225

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“…The ionic silver provides antimicrobial activity and the cuff provides a mechanical barrier to the migration of microorganisms along the external surface of the catheter. In studies of catheters left in place 120 days, the cuff failed to reduce the incidence of CRBSI [94,95]. Two other studies of short-term catheters could not demonstrate efficacy because of the minimal number of CRBSIs observed [93,96].…”

Section: Antimicrobial/antiseptic Impregnated Catheters and Cuffsmentioning

confidence: 99%

Guidelines for the prevention of intravascular catheter-related infections

O’Grady¹,

Alexander²,

Dellinger³

et al. 2002

American Journal of Infection Control

635

843

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These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The These guidelines are intended to provide evidencebased recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.

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“…Reason for exclusion Geffers, 2003 102 Review of the methodological quality of the trials available in this area of research Mermel, 2000 103 All CRBSI preventive strategies Zurcher, 2004 106 Compared single and multilumen CVCs Saint, 2000 40 Clinical and economic consequences of nosocomial CVC-related infection Bambauer, 2004 101 Narrative overview Raad, 1999 104 Narrative overview Sherertz, 2004 105 Narrative overview 3 Maki, 1988 75 Cuff vs non-cuffed ✓ ✓ Flowers, 1989 108 Cuff vs non-cuffed ✓ ✓ Kamal, 1991 109 In-house preparation ✓ ✓ ✓ of AI-CVCs Groeger, 1993 110 Cuff vs 2nd cuff ✓ ✓ Babycos, 1993 72 ✓ Bach, 1994 98 Interim results ✓ ✓ Ramsay, 1994 99 Interim results ✓ ✓ Dahlberg, 1995 111 Silver cuff vs non-cuffed ✓ Goldschmidt, 1995 112 German ✓ ✓ ✓ Smith, 1995 113 Cuff vs non-cuffed ✓ ✓ Trazzera, 1995 114 Non-RCT ✓ ✓ Appelgren, 1996 115 Standard CVC vs ✓ heparin-bonded CVC Bach, 1996 53 In-house preparation ✓ ✓ of AI-CVCs reviewed. Below are some of the issues that were raised by the reviews.…”

Section: Appendixmentioning

confidence: 99%

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

Hockenhull¹,

Dwan²,

Boland³

et al. 2008

Health Technol Assess

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Subclavian Hemodialysis Catheter Infections: A Prospective, Randomized Trial of an Attachable Silver-Impregnated Cuff for Prevention of Catheter-Related Infections

Abstract: Multiple presumed predictor variables for catheter-related infections, exit site infection rate, bacteremia rates, and semiquantitative cultures of all catheters.

Cited by 44 publications

References 23 publications

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Guidelines for the prevention of intravascular catheter-related infections

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

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