Rupp Mark E, Lisco Steven J, Lipsett Pamela A, Perl Trish M, Keating Kevin, Civetta Joseph M, Mermel Leonard A, Lee David, Dellinger E Patchen, Donahoe Michael, Giles David, Pfaller Michael A, Maki Dennis G, Sherertz Robert
University of Nebraska Medical Center, Omaha, Nebraska, USA.
Ann Intern Med. 2005 Oct 18;143(8):570-80. doi: 10.7326/0003-4819-143-8-200510180-00007.
Central venous catheter-related infections are a significant medical problem. Improved preventive measures are needed.
To ascertain 1) effectiveness of a second-generation antiseptic-coated catheter in the prevention of microbial colonization and infection; 2) safety and tolerability of this device; 3) microbiology of infected catheters; and 4) propensity for the development of antiseptic resistance.
Multicenter, randomized, double-blind, controlled trial.
9 university-affiliated medical centers.
780 patients in intensive care units who required central venous catheterization.
Patients received either a standard catheter or a catheter coated with chlorhexidine and silver sulfadiazine.
The authors assessed catheter colonization and catheter-related infection, characterized microbes by molecular typing, and determined their susceptibility to antiseptics. Patient tolerance of the catheter was monitored.
Patients with the 2 types of catheters had similar demographic features, clinical interventions, laboratory values, and risk factors for infection. Antiseptic catheters were less likely to be colonized at the time of removal compared with control catheters (13.3 vs. 24.1 colonized catheters per 1000 catheter-days; P < 0.01). The center-stratified Cox regression hazard ratio for colonization controlling for sampling design and potentially confounding variables was 0.45 (95% CI, 0.25 to 0.78). The rate of definitive catheter-related bloodstream infection was 1.24 per 1000 catheter-days (CI, 0.26 to 3.62 per 1000 catheter-days) for the control group versus 0.42 per 1000 catheter-days (CI, 0.01 to 2.34 per 1000 catheter-days) for the antiseptic catheter group (P = 0.6). Coagulase-negative staphylococci and other gram-positive organisms were the most frequent microbes to colonize catheters. Noninfectious adverse events were similar in both groups. Antiseptic susceptibility was similar for microbes recovered from either group.
The antiseptic catheter was not compared with an antibiotic-coated catheter, and no conclusion can be made regarding its effect on bloodstream infection.
The second-generation chlorhexidine-silver sulfadiazine catheter is well tolerated. Antiseptic coating appears to reduce microbial colonization of the catheter compared with an uncoated catheter.
中心静脉导管相关感染是一个重大的医学问题。需要改进预防措施。
确定1）第二代抗菌涂层导管在预防微生物定植和感染方面的有效性；2）该装置的安全性和耐受性；3）感染导管的微生物学特征；4）产生抗菌耐药性的倾向。
多中心、随机、双盲、对照试验。
9家大学附属医院。
780名重症监护病房中需要进行中心静脉置管的患者。
患者接受标准导管或涂有洗必泰和磺胺嘧啶银的导管。
作者评估导管定植和导管相关感染，通过分子分型鉴定微生物，并确定它们对防腐剂的敏感性。监测患者对导管的耐受性。
两种类型导管的患者在人口统计学特征、临床干预措施、实验室值和感染危险因素方面相似。与对照导管相比，抗菌导管在拔除时被定植的可能性较小（每1000导管日有13.3根定植导管，而对照导管为24.1根；P<0.01）。在控制抽样设计和潜在混杂变量的情况下，中心分层Cox回归分析得出的定植风险比为0.45（95%CI，0.25至0.78）。对照组明确的导管相关血流感染发生率为每1000导管日1.24例（CI，每1000导管日0.26至3.62例），抗菌导管组为每1000导管日0.42例（CI，每1000导管日0.01至2.34例）（P = 0.6）。凝固酶阴性葡萄球菌和其他革兰氏阳性菌是最常定植于导管的微生物。两组的非感染性不良事件相似。两组分离出的微生物对防腐剂的敏感性相似。
未将抗菌导管与抗生素涂层导管进行比较，因此无法就其对血流感染的影响得出结论。
第二代洗必泰-磺胺嘧啶银导管耐受性良好。与未涂层导管相比，抗菌涂层似乎可减少导管的微生物定植。
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