Comparison of Oligon catheters and chlorhexidine-impregnated sponges with standard multilumen central venous catheters for prevention of associated colonization and infections in intensive care unit patients: a multicenter, randomized, controlled study
| Autor: | Vasiliki Koulourida, Nikoleta Gerogianni, Phyllis Clouva-Molyvdas, Dimitrios Lathyris, Kostoula Arvaniti, Eleni Synnefaki, Dimitrios Matamis, Georgios Nakos, Eleni Mouloudi, Anna-Bettina Haidich, Dimitrios Georgopoulos |
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| Rok vydání: | 2011 |
| Předmět: |
Male
Quality Control Surgical Sponges medicine.medical_specialty Catheterization Central Venous Critical Care medicine.medical_treatment Critical Illness Kaplan-Meier Estimate Critical Care and Intensive Care Medicine Risk Assessment Statistics Nonparametric law.invention Catheters Indwelling law Intensive care medicine Humans Prospective Studies Analysis of Variance Greece business.industry Incidence Stem Cells Hazard ratio Chlorhexidine Equipment Design medicine.disease Intensive care unit Confidence interval Surgery Catheter Intensive Care Units Bacteremia Catheter-Related Infections Multivariate Analysis Equipment Contamination Female business Subclavian vein Central venous catheter Disinfectants |
| Zdroj: | Critical care medicine. 40(2) |
| ISSN: | 1530-0293 |
| Popis: | Objective: To evaluate silver-impregnated (Oligon) central venous catheters and chlorhexidine–gluconate-impregnated sponges for reducing catheter-related colonization and infection, nonbacteremic or bacteremic. Design: Multicenter, prospective, randomized, controlled study. Setting: Five general intensive care units in Greece. Patients: Intensive care unit patients requiring a multilumen central venous catheter between June 2006 and May 2008. Interventions: Patients were randomly assigned to receive a standard catheter (standard group), a standard catheter plus chlorhexidine–gluconate-impregnated sponge (chlorhexidine–gluconate-impregnated sponge group), or an Oligon catheter (Oligon group). Catheter colonization was defined as a positive quantitative tip culture (≥103 colony-forming units/mL), catheter-related infection was defined by the previous criterion plus clinical evidence of sepsis, and bacteremia catheter-related infection as catheter-related infection plus a positive peripheral blood culture with the same micro-organism as in the catheter tip. Measurements and Main Results: Data were obtained from 465 patients, 156 in the standard-group, 150 in the chlorhexidine–gluconate-impregnated sponge group, and 159 in the Oligon-group. Colonization occurred in 24 (15.4%) standard catheters, 21 (14%) in the chlorhexidine–gluconate-impregnated sponge group, and 25 (15.7%) in the Oligon catheters (p = .35) (20.9, 19.9, 21.8/1000 catheter-days, respectively). Catheter-related infections were recorded in nine (5.8%) standard catheters, six (4%) in the chlorhexidine–gluconate-impregnated sponge group, and seven (4.4%) in the Oligon catheters (p = .58) (7.8/1,000, 5.7/1,000, 6.1/1,000 catheter-days, respectively). No difference was observed between the chlorhexidine– gluconate-impregnated sponge group and the standard group regarding catheter colonization (hazard ratio 1.21; 95% confidence interval 0.56–2.61; p = .64) and catheter-related infections (hazard ratio 0.65; 95% confidence interval 0.23–1.85; p = .42). The Oligon catheter did not reduce colonization or catheter-related infections when compared with the standard catheter (colonization: hazard ratio 1.0; 95% confidence interval 0.46–2.21; p = .98; catheter-related infection: hazard ratio 0.72; 95% confidence interval 0.27–1.95; p = .52). Seven patients (1.5%, 2.09/1,000 catheter-days) presented bacteremic catheter-related infections. Central venous catheters inserted either in the internal jugular or the femoral vein had greater risk to be colonized than catheters inserted in the subclavian vein (internal jugular vs. subclavian: hazard ratio 3.29; 95% confidence interval 1.26–8.61; p = .01; femoral vs. subclavian: hazard ratio 3.36; 95% confidence interval 1.17–9.65; p = .02). Acinetobacter baumannii was the predominant pathogen (37.1% episodes of colonization, 36.4% catheter-related infections, 57.1% bacteremic catheter-related infections). Conclusion: For short-term (median duration 7 days) central venous catheters in intensive care units with high prevalence of multiresistant Gram-negative bacteria, chlorhexidine-impregnated sponges and Oligon catheters as single preventive measures did not reduce catheter colonization or catheter-related infections. As a result of the limited amount of events, no conclusion could be reached regarding bacteremic catheter-related infections. The femoral site was the most frequently colonized insertion site in all types of catheters. |
| Databáze: | OpenAIRE |
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