Preliminary results of a prospective randomized study comparing the effect of double-lumen central venous catheters impregnated with chlorhexidine and silver sulfadiazine with the standard on colonization

Introduction

Central venous catheters (CVC) are frequently used in the intensive care (ICU) setting. A wide number of strategies have been studied to prevent colonization and infection related to CVC. One of them is the use of antimicrobial-impregnated catheters, but no positive effect has been shown primarily for triple-lumen catheters.

Objective

To compare the incidence of CVC colonization in two groups of patients using a double-lumen CVC impregnated with chlorhexidine and silver sulfadiazine, or the standard one.

Patients and methods

Patients undergoing insertion of a double-lumen CVC in the ICU were randomized to receive either a VCV impregnated with chlorhexidine and silver sulfadiazine, or the standard one. The catheter tips were cultured by the roll-plate method after removal.

Results

Sixty patients enrolled with successful insertion of 60 catheters, 24 of them impregnated (group 1) and 36 standards (group 2). There were no statistically significant differences between the groups in age, seven infection-related risk factors, ICU diagnosis, mean Sepsis-related Organ Failure Assessment score, insertion sites, duration of catheterization, wrong location at X-ray, signs of allergy, and catheter colonization rates. The mean times of duration of catheterization in group 1 and group 2 were 14.5 ± 8.3 days and 13.8 ± 6.2 days respectively (P = 0.8). The mean Sepsis-related Organ Failure Assessment scores in groups 1 and 2 were 5.4 ± 3.4 and 5.2 ± 3.3, respectively (P = 0.8). The colonization rates were 23.1% (six catheters) in group 1 and 29.4% (10 catheters) in group 2 (P = 0.5). The impregnated catheters presented a trend of being removed more frequently due to systemic infection suspicion (P = 0.05). Fifteen catheters presented Gram-positive cocci, four of them associated with Gram-negative bacilli and two with fungi. One catheter presented two Gram-negative bacilli in the roll plate.

Conclusion

This preliminary analysis of the comparative study between a double-lumen CVC impregnated with chlorhexidine and silver sulfadiazine and the standard one did not show any statistically significant difference in colonization rates between the two groups.