Influence of Triple-Lumen Central Venous Catheters Coated With Chlorhexidine and Silver Sulfadiazine on the Incidence of Catheter-Related Bacteremia

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Abstract
DESPITE IMPROVEMENT in central venous catheter (CVC) design and insertion techniques, catheter-related infections continue to be a significant problem in the intensive care unit.1-3 One popular strategy to reduce these infections is scheduled CVC change over a guidewire; however, several studies4,5 have indicated that this approach does not reduce the risk of infection. A collagen cuff impregnated with silver that fits around the CVC and resides in a subcutaneous pocket was shown to reduce the density of growth of bacteria on the catheter in some but not all studies.6-9 None of these studies individually demonstrated a statistically significant reduction in the incidence of catheter-related bacteremia (CRB); however, pooled data from 2 studies6,7 suggest that the use of the cuff resulted in a significant decrease in the rate of CRB.7 This product has not gained widespread popularity possibly because the use of the cuff can be cumbersome and a substantial portion of these cuffs extrude from their pockets over time. Antibiotic-bonded CVCs have been used in several animal and clinical studies,10-13 but concerns about the emergence of resistant organisms and the time needed to bond the catheter with antibiotics at the bedside has limited the use of this approach. The CVC coated with the antiseptic combination product of chlorhexidine and silver sulfadiazine (CSS) represents the latest strategy to combat catheter infections. Although several recent abstracts suggest that these coated CVCs are effective in reducing the local burden of bacterial growth and the incidence of CRB,14-16 2 recent studies17,18 evaluating these catheters in patients receiving total parenteral nutrition suggest a lack of efficacy. We present our results of a prospective randomized study comparing the efficacy of CVCs coated with CSS compared with uncoated CVCs in reducing the incidence of catheter-related infctions.

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