Efficiency of rifampicin–miconazole-impregnated catheters in the femoral venous site

Introduction

The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial or antiseptic-impregnated catheter for short-term catheterization and recommend avoiding femoral access to reduce the risk of central venous catheter-related bacteremia (CVC-RB). The objective of this study was to determine the incidence of CVC-RB with rifampicin–miconazole-impregnated catheters (RM-C) and standard catheters (S-C) in femoral venous access; and the cost of CVC-RB with both types of catheter.

Methods

A cohort study, conducted in a 24-bed polyvalent medical–surgical ICU of a university hospital. We included patients admitted to the ICU from 1 June 2006 to 30 September 2007, who underwent femoral venous catheterization. The cost of CVC-RB included the cost of antimicrobial agents and the diagnosis methods; but other costs were not included (such as prolongation of ICU stay, mechanical ventilation, extrarenal depuration, etc.).

Results

We inserted 73 RM-C during 634 catheter-days and 111 S-C during 927 catheter-days. We diagnosed eight CVC-RB in the S-C group and none in the RM-C group. The incidence of CVC-RB with RM-C was significantly lower than with S-C (0 vs. 8.62 per 1,000 catheter-days, OR = 0.13, 95% CI = 0.00 to 0.86; P = 0.03). The total cost in the RM-C group was €7,300 (73 central venous catheters (CVC) per €100 each CVC, and none CVC-RB), the mean cost per catheter was €100 (€7,300/73 CVC), and the mean cost per catheter-day was €11.51 (€7,300/634 CVC-days). The total cost in the S-C group was € 15,330 (111 CVC per €30 each CVC = €3,330, more than € 12,000 per the eight CVC-RB), the mean cost per catheter was €138 (€15,330/111 CVC), and the mean cost per catheter-day was €16.54 (€15,330/927 CVC-days).

Conclusion

RM-C could decrease the incidence of femoral venous catheter-related bacteremia and are more efficient than standard catheters.