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Anti-infective external coating of central venous catheters: A randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization.

Author(s): Walz JM, Avelar RL, Longtine KJ, Mermel LA, Heard SO, for the 5-FU Catheter Study Group

Affiliation(s): From the Departments of Anesthesiology and Surgery (JMW, KJL, SOH), UMass Memorial Medical Center, Worcester, MA; Angiotech Pharmaceuticals, Inc (RLA), Vancouver, BC, Canada; and the Department of Medicine (LAM), Warren Alpert Medical School of Brown University and the Division of Infectious Diseases, Rhode Island Hospital, Providence, RI.

Publication date & source: 2010-08-12, Crit Care Med., [Epub ahead of print]

OBJECTIVE:: The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine. DESIGN:: Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial. SETTING:: Twenty-five US medical center intensive care units. PATIENTS:: A total of 960 adult patients requiring central venous catheterization for up to 28 days. INTERVENTIONS:: Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480). MEASUREMENTS AND MAIN RESULTS:: The primary antimicrobial outcome was a dichotomous measure (<15 colony-forming units or >/=15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings. CONCLUSIONS:: Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective alternative to catheters externally coated with chlorhexidine and silver sulfadiazine when used in critically ill patients.

Page last updated: 2010-10-05

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