Clinical review: new technologies for prevention of intravascular catheter-related infections

Stefania Cicalini, Fabrizio Palmieri, Nicola Petrosillo, Stefania Cicalini, Fabrizio Palmieri, Nicola Petrosillo

Abstract

Intravascular catheters have become essential devices for the management of critically and chronically ill patients. However, their use is often associated with serious infectious complications, mostly catheter-related bloodstream infection (CRBSI), resulting in significant morbidity, increased duration of hospitalization, and additional medical costs. The majority of CRBSIs are associated with central venous catheters (CVCs), and the relative risk for CRBSI is significantly greater with CVCs than with peripheral venous catheters. However, most CVC-related infections are preventable, and different measures have been implemented to reduce the risk for CRBSI, including maximal barrier precautions during catheter insertion, catheter site maintenance, and hub handling. The focus of the present review is on new technologies for preventing infections that are directed at CVCs. New preventive strategies that have been shown to be effective in reducing risk for CRBSI, including the use of catheters and dressings impregnated with antiseptics or antibiotics, the use of new hub models, and the use of antibiotic lock solutions, are briefly described.

References

    1. Centers for Disease Control and Prevention Guidelines for the prevention of intravascular catheter-related infections. MMWR Recomm Rep. 2002;51(RR-10):1–29.
    1. Mermel LA. New technologies to prevent intravascular catheter-related bloodstream infections. Emerg Infect Dis. 2001;7:197–199.
    1. Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, Galicier C, Veron M, Boisivon A, Bouvier AM. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central-catheter cultures in intensive care unit patients. J Clin Microbiol. 1990;28:2520–2525.
    1. Collignon PJ. Intravascular catheter associated sepsis: a common problem. The Australian Study on Intravascular Catheter Associated Sepsis. Med J Aust. 1994;161:374–378.
    1. Garland JS, Alex CP, Mueller CD, Otten D, Shivpuri C, Harris MC, Naples M, Pellegrini J, Buck RK, McAuliffe TL, Goldmann DA, Maki DG. A randomised trial comparing povidone-iodine to a chlorhexidine gluconate impregnated dressing for prevention of central venous catheter infections in neonates. Pediatrics. 2001;107:1431–1437.
    1. Bonawitz SC, Hammell EJ, Kirkpatrick JR. Prevention of central venous catheter sepsis: a prospective randomized trial. Am Surg. 1991;57:618–623.
    1. Maki DG, Cobb L, Garman JK, Chapiro JM, Ringer M, Helgerson RB. An attachable silver-impregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med. 1988;85:307–314.
    1. Flowers RHD, Schenzer KJ, Kopel RF, Fish MJ, Tucker SI, Farr BM. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection: a randomized, controlled trial. JAMA. 1989;261:878–883. doi: 10.1001/jama.261.6.878.
    1. Smith HO, DeVictoria CL, Garfinkel D, Anderson P, Goldberg GL, Soeiro R, Elia G, Runowicz CD. A prospective randomized comparison of an attached silver-impregnated cuff to prevent central venous catheter-associated infection. Gynecol Oncol. 1995;58:92–100. doi: 10.1006/gyno.1995.1189.
    1. Dahlberg PJ, Agger WA, Singer JR, Yutuc WR, Newcomer KL, Schaper A, Rooney BL. Subclavian haemodialysis catheter infections: a prospective randomized trial of an attachable silver impregnated cuff for prevention of catheter-related infections. Infect Control Hosp Epidemiol. 1995;16:506–511.
    1. Groeger JS, Lucas AB, Coit D, LaQuaglia M, Brown AE, Turnbull A, Exelby P. A prospective, randomized evaluation of the effect of silver impregnated subcutaneous cuffs for preventing tunnelled chronic venous access catheter infections in cancer patients. Ann Surg. 1993;218:206–210.
    1. Greenfild JI, Sampath L, Popiskis SJ, Brunnert SR, Stylianos S, Modak S. Decreased bacterial adherence and biofilm formation on chlorexidine and silver sulfadiazine impregnated central venous catheters implanted in swine. Crit Care Med. 1995;23:894–900. doi: 10.1097/00003246-199505000-00018.
    1. Kamal GD, Pfaller MA, Rempe LE, Jebson PJ. Reduced intravascular catheter infection by antibiotic bolding. JAMA. 1991;265:2364–2368. doi: 10.1001/jama.265.18.2364.
    1. Maki DG, Stolz SM, Wheeler S, Mermel LA. Prevention of central venous catheter-related infection by use of an antiseptic impregnated catheter. A randomized, controlled trial. Ann Intern Med. 1997;127:257–266.
    1. Raad I, Darouiche R, Dupuis J, Abi-Said D, Gabrielli A, Hachem R, Wall M, Harris R, Jones J, Buzaid A, Robertson C, Shenaq S, Curling P, Burke T, Ericsson C. Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infection: a randomized, double-bind trial. The Texas Medical Center Catheter Study Group. Ann Intern Med. 1997;127:267–274.
    1. Bach A, Bohrer H, Motsh J, Martin E, Geiss HK, Sonntag HG. Prevention of bacterial colonization of intravenous catheters by antiseptic impregnation of polyurethane polymers. J Antimicrobial Chemother. 1994;33:969–978.
    1. Veenstra DL, Saint S, Saha S, Lumeley T, Sullivan SD. Efficacy of antiseptic-impregnated central venous catheters in preventing catheter related bloodstream infection: a meta-analysis. JAMA. 1999;281:261–267. doi: 10.1001/jama.281.3.261.
    1. Bach A, Schmidt H, Bottiger B, Schreiber B, Bohrer H, Motsch J, Martin E, Sonntag HG. Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J Antimicrob Chemoter. 1996;37:315–322.
    1. Logghe C, Van Ossel C, D'Hoore W, Ezzedine H, Wauters G, Haxhe JJ. Evaluation of chlorexidine and silver sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemia patients: a randomized controlled trial. J Hosp Infect. 1997;37:145–156. doi: 10.1016/S0195-6701(97)90184-5.
    1. Raad I, Darouiche R, Hachem R, Mansouri M, Bodey GP. The broad-spectrum activity and efficacy of catheter coated with minocycline and rifampin. J Infect Dis. 1996;173:418–424.
    1. Bassetti S, Hu J, D'Agostino RB, Jr, Sherertz RJ. Prolonged antimicrobial activity of a catheter containing chlorhexidine-silver sulfadiazine extends protection against catheter infections in vivo. Antimicrob Agents Chemoter. 2001;45:1535–1538. doi: 10.1128/AAC.45.5.1535-1538.2001.
    1. Oda T, Hamasaki J, Kanda N, Mikami K. Anaphylactic shock induced by an antiseptic-coated central venous catheter. Anesthesiology. 1997;87:1242–1244. doi: 10.1097/00000542-199711000-00031.
    1. Stephens R, Mythen M, Kallis P, Davies DW, Egner W, Rickards A. Two episodes of life-threatening anaphylaxis in the same patient to a chlorhexidine-sulphadiazine-coated central venous catheter. Br J Anaesth. 2001;87:306–308. doi: 10.1093/bja/87.2.306.
    1. Crnich CJ, Maki DG. The promise of novel technology for the prevention of intravascular device-related bloodstream infection. I. Pathogenesis and short-term devices. Clin Infect Dis. 2002;34:1232–1242. doi: 10.1086/339863.
    1. Darouiche RO, Raad II, Heard SO, Thornby JI, Wenker OC, Gabrielli A, Berg J, Khardori N, Hanna H, Hachem R, Harris RL, Mayhall G. A comparison of two antimicrobial impregnated central venous catheters. N Engl J Med. 1999;340:1–8. doi: 10.1056/NEJM199901073400101.
    1. Raad II, Darouiche RO, Hachem R, Abi-Said D, Safar H, Darnule T, Mansouri M, Morck D. Antimicrobial durability and rare ultrastructural colonization of indwelling central catheters coated with minocycline and rifampin. Crit Care Med. 1998;26:219–224. doi: 10.1097/00003246-199802000-00015.
    1. Marciante KD, Veenstra DL, Lipsky BA, Saint S. Which antimicrobial impregnated catheter should we use? Modelling the costs and outcomes of antimicrobial catheter use. Am J Infect Control. 2003;31:1–8. doi: 10.1067/mic.2003.35.
    1. Tambe SM, Sampath L, Modak SM. In vitro evaluation of the risk of developing bacterial resistance to antiseptics and antibiotics used in medical devices. J Antimicrob Chemother. 2001;47:589–598. doi: 10.1093/jac/47.5.589.
    1. Ranucci M, Isgro G, Giomarelli PP, Pavesi M, Luzzani A, Cattabriga I, Carli M, Giomi P, Compostella A, Digito A, Mangani V, Silvestri V, Mondelli E, Catheter Related Infection Trial (CRIT) Group Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection. Crit Care Med. 2003;3:52–59. doi: 10.1097/00003246-200301000-00008.
    1. Liu WK, Tebbs SE, Byrne PO, Elliott TS. The effects of electric current on bacteria colonizing intravenous catheters. J Infect. 1993;27:261–269.
    1. Raad I, Hachem R, Zermeno A, Dumo M, Bodey GP. In vitro antimicrobial efficacy of silver iontophoretic catheters. Biomaterials. 1996;17:1055–1059. doi: 10.1016/0142-9612(96)85905-9.
    1. Segura M, Alvarez-Lerma F, Tellado JM, Jimenez-Ferreres J, Oms L, Rello J, Baro T, Sanchez R, Morera A, Mariscal D, Marrugat J, Sitges-Serra A. A clinical trial on the prevention of catheter-related sepsis using a new hub model. Ann Surg. 1996;223:363–369. doi: 10.1097/00000658-199604000-00004.
    1. Luna J, Masdeu G, Perez M, Claramonte R, Forcadell I, Barrachina F, Panisello M. Clinical trial evaluating a new hub device designate to prevent catheter-related sepsis. Eur J Clin Microbiol Infect Dis. 2000;19:655–662. doi: 10.1007/s100960000346.
    1. Halpin DP, O'Byrne P, Mc Entee G, Hennessy TP, Stephens RB. Effects of a Betadine connection shield on central venous catheters sepsis. Nutrition. 1991;7:33–34.
    1. Mendelson MH, Short LJ, Schechter CB, Meyers BR, Rodriguez M, Cohen S, Lozada J, DeCambre M, Hirschman SZ. Study of needleless intermittent intravenous access system for peripheral infusions: analysis of staff patient, and institutional outcomes. Infect Control Hosp Epidemiol. 1998;19:401–406.
    1. Danzig LE, Short LJ, Collins K, Mahoney M, Sepe S, Bland L, Jarvis WR. Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy. JAMA. 1995;273:1862–1864. doi: 10.1001/jama.273.23.1862.
    1. Cookson ST, Ihrig M, O'Mara EM, Denny M, Volk H, Banerjee SN, Hartstein AI, Jarvis WR. Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device. Infect Control Hosp Epidemiol. 1998;19:28–31.
    1. Kellerman S, Shay DK, Howard J, Goes C, Feusner J, Rosenberg J, Vugia DJ, Jarvis WR. Bloodstream infections in home infusion patients: the influence of race and needleless intravescular devices. J Pediatr. 1996;129:711–717.
    1. Do AN, Ray BJ, Banerjee SN, Illian AF, Barnett BJ, Pham MH, Hendricks KA, Jarvis WR. Bloodstream infection associated with needleless devices use and the importance of infection control practices in the home health care setting. J Infect Dis. 1999;179:442–448. doi: 10.1086/314592.
    1. Seymour VM, Dhallu TS, Moss HA, Tebbs SE, Elliot TS. A prospective clinical study to investigate the microbial contamination of a needleless connector. J Hosp Infect. 2000;45:165–168. doi: 10.1053/jhin.2000.0726.
    1. Rackoff WR, Weiman M, Jakobowski D, Hirschl R, Stallings V, Bilodeau J, Danz P, Bell L, Lange B. A randomized, controlled trial of the efficacy of a heparin and vancomycin solution in preventing central venous catheter infection in children. J Pediatr. 1995;127:147–151.
    1. Shwartz C, Henrickson KJ, Roghmann K, Powell K. Prevention of bacteremia attributed to luminal colonization of tunnelled central venous catheter with vancomycin susceptible organisms. J Clin Oncol. 1990;8:591–597.
    1. Raad II, Hanna HA. Intravascular catheter-related infections. New horizons and recent advances. Arch Intern Med. 2002;162:871–878. doi: 10.1001/archinte.162.8.871.
    1. Henrickson KJ, Axtell RA, Hoover SM, Kuhn SM, Pritchett J, Kehl SC, Klein JP. Prevention of central venous catheter-related infections and thrombotic events in immunocompromised children by the use of vancomycin/ciprofloxacin/heparin flush solutions: a randomized, multicenter, double-blind trial. J Clin Oncol. 2000;18:1269–1278.
    1. Centers for Disease Control and Prevention. Recommendations for preventing the spread of vancomycin resistance. Recommendations of the Hospital Infection Control Practices Advisory Committee (HICPAC) MMWR Recomm Rep. 1995;44(RR-12):1–13.
    1. Raad I, Buzaid A, Rhyne J, Hachem R, Darouiche R, Safar H, Albitar M, Sherertz RJ. Minocycline and etylenediaminetetraacetate for the prevention of recurrent vascular catheter infections. Clin Infect Dis. 1997;25:149–151.
    1. Chatzinikolaou I, Zipf TF, Hanna H, Umphrey J, Roberts WM, Sherertz R, Hachem R, Raad I. Minocycline-ethylenediamine tetracetate lock solution for the prevention of implantable port infections in children with cancer. Clin Infect Dis. 2003;36:116–119. doi: 10.1086/344952.
    1. Raad II, Luna M, Khalil SA, Costerton JW, Lam C, Bodey GP. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA. 1994;271:1014–1016. doi: 10.1001/jama.271.13.1014.
    1. Timsit JF, Farkas JC, Boyer JM, Martin JB, Misset B, Renaud B, Carlet J. Central vein catheter-related thrombosis in intensive care patients: incidence, risk factors, and relationship with catheter-related sepsis. Chest. 1998;113:165–171.
    1. Pierce CM, Wade A, Mok Q. Heparin-bonded central venous lines reduce thrombotic and infective complications in critically ill children. Intensive Care Med. 2000;26:967–972. doi: 10.1007/s001340051289.
    1. Randolph AG, Cook DJ, Gonzales CA, Andrew M. Benefit of heparin in central venous and pulmonary artery catheters: a meta-analysis of randomised controlled trials. Chest. 1998;113:165–171.
    1. Donelli G, Francolini I, Piozzi A, Di Rosa R, Marconi W. New polymer-antibiotic systems to inhibit bacterial biofilm formation: a suitable approach to prevent central venous catheter-associated infections. J Chemother. 2002;14:501–507.
    1. Schmidt S, Haase G, Csomor E, Lutticken R, Peltroche-Llacsahuanga H. Inhibitor of complement, Compstatin, prevents polymer-mediated Mac-1 up-regulation of human neutrophils independent of biomaterial type tested. J Biomed Mater Res. 2003;66A:491–499. doi: 10.1002/jbm.a.10031.
    1. Parsek MR, Val DL, Hanzelka BL, Cronan JE, Jr, Greenberg EP. Acyl homoserine-lactone quorum-sensing signal generation. Proc Natl Acad Sci USA. 1999;96:4360–4365. doi: 10.1073/pnas.96.8.4360.
    1. Davies DG, Parsek MR, Pearson JP, Iglewski BH, Costerton JW, Greenberg EP. The involvement of cell-to-cell signals in the development of a bacterial biofilm. Science. 1998;280:295–298. doi: 10.1126/science.280.5361.295.

Source: PubMed

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