Raad I I, Darouiche R O, Hachem R, Abi-Said D, Safar H, Darnule T, Mansouri M, Morck D
University of Texas M. D. Anderson Cancer Center, Section of Infectious Diseases, Houston 77030, USA.
Crit Care Med. 1998 Feb;26(2):219-24. doi: 10.1097/00003246-199802000-00015.
To determine the duration of antimicrobial activity and the efficacy of indwelling catheters coated with minocycline and rifampin in preventing ultrastructural colonization.
Multicenter, prospective, randomized, clinical trial.
Five university-based medical centers.
Cohort 1 consisted of 40 randomized patients in whom an equal number of minocycline- and rifampin-coated and uncoated catheters were inserted and studied using scanning electron microscopy. Cohort 2 consisted of 118 patients who received coated catheters that were tested for the antimicrobial activity and levels of the antibiotics at the time of removal.
Catheters pretreated with tridodecylmethylammonium chloride and subsequently coated with minocycline and rifampin; uncoated catheters (control).
Quantitative scanning electron microscopy was utilized to determine both the ultrastructural colonization in biofilm on coated and uncoated catheters. The zones of inhibition of coated catheters from studied patients against Staphylococcus epidermidis was used to determine the antimicrobial durability. High-performance liquid chromatography was used to determine antibiotic levels on indwelling coated catheters and in serum. Mild-to-heavy ultrastructural colonization was detected in 7 (35%) of 20 coated catheters and in 16 (80%) of 20 uncoated catheters (p = .004). Significant antimicrobial inhibitory activity against S. epidermidis was maintained for 16 days. Rifampin and minocycline continued to be detected on the surfaces of coated catheters for at least 2 wks after placement. Neither antibiotic was detected in the 60 serum samples obtained from 15 patients during catheterization.
Coating catheters with minocycline and rifampin inhibits ultrastructural colonization of indwelling catheters and maintains effective antimicrobial activity for at least 2 wks.
确定涂有米诺环素和利福平的留置导管预防超微结构定植的抗菌活性持续时间及效果。
多中心、前瞻性、随机临床试验。
五所大学附属医院。
队列1由40名随机分组患者组成，其中同等数量的涂有米诺环素和利福平的导管及未涂覆导管被插入，并使用扫描电子显微镜进行研究。队列2由118名接受涂覆导管的患者组成，在导管拔除时对其进行抗菌活性及抗生素水平检测。
用三癸基甲基氯化铵预处理导管，随后涂覆米诺环素和利福平；未涂覆导管（对照）。
采用定量扫描电子显微镜确定涂覆和未涂覆导管生物膜中的超微结构定植情况。利用研究患者的涂覆导管对表皮葡萄球菌的抑菌圈来确定抗菌耐久性。采用高效液相色谱法测定留置涂覆导管及血清中的抗生素水平。在20根涂覆导管中有7根（35%）检测到轻度至重度超微结构定植，而在20根未涂覆导管中有16根（80%）检测到（p = 0.004）。对表皮葡萄球菌的显著抗菌抑制活性持续了16天。放置后至少2周，在涂覆导管表面仍可检测到利福平和米诺环素。在置管期间从15名患者采集的60份血清样本中均未检测到这两种抗生素。
用米诺环素和利福平涂覆导管可抑制留置导管的超微结构定植，并维持至少2周的有效抗菌活性。
