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CRITICAL CARE AND TRAUMA

Central Venous Catheter Colonization in Critically Ill Patients: A Prospective, Randomized, Controlled Study Comparing Standard with Two Antiseptic-Impregnated Catheters

Martin W. Dünser, MD^*, Andreas J. Mayr, MD^*, Guido Hinterberger, PhD, Cornelia Lass Flörl, MD, Hanno Ulmer, PhD, Stefan Schmid, MD^*, Barbara Friesenecker, MD^*, Ingo Lorenz, MD^*, and Walter R. Hasibeder, MD

*Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, Institute for Hospital Hygienics and Social Medicine, and Institute for Medical Biostatistics, Innsbruck Medical University; Department of Anesthesia and Critical Care Medicine, Krankenhaus der Barmherzigen Schwestern, Ried I. Innkreis, Austria

Address correspondence and reprint requests to Martin W. Dünser, MD, Division of General and Surgical Intensive Care Medicine, Department of Anesthesia and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. Address e-mail to Martin.Duenser{at}uibk.ac.at.

In this prospective, randomized, controlled, unblinded study, we compared colonization rates of a standard, unimpregnated central venous catheter (CVC) with rates for silver-coated and chlorhexidine-silversulfadiazine (CH-SS)-impregnated CVC. Patient characteristics, CVC insertion site, indwelling time, and colonization detected by semiquantitative and quantitative microbiologic techniques were documented. Two-hundred-seventy-five critically ill patients were included into the study protocol. One-hundred-sixty standard, 160 silver (S)-coated, and 165 externally impregnated CH-SS CVC were inserted. There was a significant difference in CVC colonization rates among study groups (P = 0.029). There was no difference in the colonization rate and the colonization per 1000 catheter days between standard and S-coated (P = 0.564; P = 0.24) or CH-SS-coated CVC (P= 0.795; P = 0.639). When comparing antiseptic CVC with each other, colonization rates were significantly less with CH-SS-impregnated than with S-coated CVC (16.9% versus 7.3%; P = 0.01; 18.2 versus 7.5 of 1000 catheter days; P = 0.003; relative risk, 0.43; 95% confidence interval, 0.21–0.85). Whereas standard and S-coated CVC were first colonized 2 and 3 days after insertion, respectively, CH-SS CVC were first colonized only after 7 days. In conclusion, antiseptic-impregnated CVC could not prevent catheter colonization when compared with standard polyurethane catheters in a critical care setting with infrequent catheter colonization rates and CVC left in place for >10 days.

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999