Reduction of bacterial colonization and catheter-related infection with antiseptic central venous catheter: a randomized controlled clinical trial

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Author:
YANG Jun(Department of Critical Care Medicine, the General Hospital of Chinese People' s Armed Police Forces, Beijing 100039, China)
CHENG Rui(Department of Critical Care Medicine, the General Hospital of Chinese People' s Armed Police Forces, Beijing 100039, China)
GONG Jing(Department of Critical Care Medicine, the General Hospital of Chinese People' s Armed Police Forces, Beijing 100039, China)
XI Jing-jing()
Journal Title:
CHINESE JOURNAL OF CLINICAL INFECTIOUS DISEASES
Issue:
Volume 04, Issue 03, 2011
DOI:
10.3760/cma.j.issn.1674-2397.2011.03.004
Key Word:
Catheterization, central venous;Infection;Bacteria colonization;Randomized controlled trials

Abstract: Objective To investigate whether antiseptic central venous catheters (CVC) modified with chlorhexidine acetate and silver sulfadiazine can be beneficial in reducing bacterial colonization and catheter-related infection. Methods Prospective controlled non-blinded randomized clinical trial was conducted. Seventy adult inpatients with CVC from intensive care unit of General Hospital of Chinese People's Armed Police Force during June 2007-June 2009 were enrolled. Their baseline characteristics, APACHE Ⅱ score and therapeutic interventions were comparable. Patients were randomly received either an antiseptic CVC ( antiseptic group, n = 28) or a standard two-lumen CVC ( control group, n = 42 ). Microbiological evaluation was done after CVC removal. A catheter bacterial colonization ( CBC) was considered if bacterial growth of > 15 CFU was found by semi-quantitative roll-plate technique from a proximal or distal catheter segment. A catheter-related infection ( CRI) was defined as a colonized catheter with local signs of inflammation. A catheter-related bloodstream infection ( CR-BSI) was defined as a colonized catheter with isolation of the same organism from the patient' s blood with accompanying clinical signs of infection. SPSS 11.5 software was used for statistical analysis. Kaplan Meier curve was used to evaluate the association between CVC retention time and bacterial colonization or infection, and Log-rank test was performed to compare between the groups. Results CVC was removed from 3.6% (1/28) patients of antiseptic group and 21.4% (9/42) patients of control group because of infection (x2 = 5. 143, P <0. 05). Colonization of CVC was observed in 7. 1% (2/28) patients from antiseptic group and 35. 7% ( 15/42) from control group (x2 =7.458, P<0.01). CBC or CRI was not observed in antiseptic group until day 19, while CRI occurred at day 6 in the control group. CVC colonization and infection were developed in 31.4% and 14. 3% patients of antiseptic group during day 14-day 28 respectively, while the rates in the control group were 90% and 70% ( u = 27.5 and 14.31, P < 0.01). Conclusions Antiseptic CVC modified with chlorhexidine acetate and silver sulfadiazine can significantly lower the risks of CBC and CRI. But more than 50% patients would develop infection when colonization occured, no matter patients receive standard or antiseptic CVC. After CVCs have been inserted for > 2 weeks, the colonization and infection will increase significantly in both standard or antiseptic CVC, so to shorten the insertion time is an effective measure to decrease the CVC-related infection.

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