Comparison of Antimicrobial Impregnation With Tunneling of Long-term Central Venous Catheters

Abstract

In Brief Objective: We sought to compare the impact of antimicrobial impregnation to that of tunneling of long-term central venous catheters on the rates of catheter colonization and catheter-related bloodstream infection. Summary Background Data: Tunneling of catheters constitutes a standard of care for preventing infections associated with long-term vascular access. Although antimicrobial coating of short-term central venous catheters has been demonstrated to protect against catheter-related bloodstream infection, the applicability of this preventive approach to long-term vascular access has not been established. Methods: A prospective, randomized clinical trial in 7 university-affiliated hospitals of adult patients who required a vascular access for ≥2 weeks. Patients were randomized to receive a silicone central venous catheter that was either impregnated with minocycline and rifampin or tunneled. The occurrence of catheter colonization and catheter-related bloodstream infection was determined. Results: Of a total of 351 inserted catheters, 346 (186 antimicrobial-impregnated and 160 tunneled) were analyzed for catheter-related bloodstream infection. Clinical characteristics were comparable in the 2 study groups, but the antimicrobial-impregnated catheters remained in place for a shorter period of time (mean, 30.2 versus 43.8 days). Antimicrobial-impregnated catheters were as likely to be colonized as tunneled catheters (7.9 versus 6.3 per 1000 catheter-days). Bloodstream infection was 4 times less likely to originate from antimicrobial-impregnated than from tunneled catheters (0.36 versus 1.43 per 1000 catheter-days). Conclusions: Antimicrobial impregnation of long-term central venous catheters may help obviate the need for tunneling of catheters. In this prospective, randomized, multicenter clinical trial, long-term central venous catheters impregnated with minocycline and rifampin were 4-fold less likely than tunneled unimpregnated catheters to result in bloodstream infection. Antimicrobial impregnation may help obviate the need for the less protective and the more expensive and cumbersome practice of tunneling catheters.