Comparison of antimicrobial impregnation with tunneling of long-term central venous catheters: a randomized controlled trial.

Author(s): Darouiche RO, Berger DH, Khardori N, Robertson CS, Wall MJ Jr, Metzler MH, Shah S, Mansouri MD, Cerra-Stewart C, Versalovic J, Reardon MJ, Raad II

Affiliation(s): Center for Prostheses Infection, Baylor College of Medicine, Houston, Texas 77030, USA. rdarouiche@aol.com

Publication date & source: 2005-08, Ann Surg., 242(2):193-200.

Publication type: Clinical Trial; Randomized Controlled Trial

OBJECTIVE: We sought to compare the impact of antimicrobial impregnation to that of tunneling of long-term central venous catheters on the rates of catheter colonization and catheter-related bloodstream infection. SUMMARY BACKGROUND DATA: Tunneling of catheters constitutes a standard of care for preventing infections associated with long-term vascular access. Although antimicrobial coating of short-term central venous catheters has been demonstrated to protect against catheter-related bloodstream infection, the applicability of this preventive approach to long-term vascular access has not been established. METHODS: A prospective, randomized clinical trial in 7 university-affiliated hospitals of adult patients who required a vascular access for > or = 2 weeks. Patients were randomized to receive a silicone central venous catheter that was either impregnated with minocycline and rifampin or tunneled. The occurrence of catheter colonization and catheter-related bloodstream infection was determined. RESULTS: Of a total of 351 inserted catheters, 346 (186 antimicrobial-impregnated and 160 tunneled) were analyzed for catheter-related bloodstream infection. Clinical characteristics were comparable in the 2 study groups, but the antimicrobial-impregnated catheters remained in place for a shorter period of time (mean, 30.2 versus 43.8 days). Antimicrobial-impregnated catheters were as likely to be colonized as tunneled catheters (7.9 versus 6.3 per 1000 catheter-days). Bloodstream infection was 4 times less likely to originate from antimicrobial-impregnated than from tunneled catheters (0.36 versus 1.43 per 1000 catheter-days). CONCLUSIONS: Antimicrobial impregnation of long-term central venous catheters may help obviate the need for tunneling of catheters.