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    Anti-infective external coating of central venous catheters: a randomized, noninferiority trial comparing 5-fluorouracil with chlorhexidine/silver sulfadiazine in preventing catheter colonization

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    Authors
    Walz, J. Matthias
    Avelar, Rui L.
    Longtine, Karen J.
    Carter, Kent L.
    Mermel, Leonard A.
    Heard, Stephen O.
    5-FU Catheter Study Group
    Faris, Khaldoun
    Hall, Wiley R.
    Orquiola, Alan
    O'Neill, Melissa A.
    Longtine, Jaclyn K.
    Show allShow less
    UMass Chan Affiliations
    Department of Surgery
    Department of Anesthesiology
    Document Type
    Journal Article
    Publication Date
    2010-11-01
    Keywords
    Anti-Infective Agents, Local
    Antibiotic Prophylaxis
    Antimetabolites
    Catheter-Related Infections
    Catheterization, Central Venous
    Catheters, Indwelling
    Chlorhexidine
    Colony Count, Microbial
    Female
    Fluorouracil
    Humans
    Intensive Care
    Male
    Middle Aged
    Prospective Studies
    Silver Sulfadiazine
    Single-Blind Method
    Treatment Outcome
    Anesthesiology
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    Metadata
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    Link to Full Text
    http://dx.doi.org/10.1097/CCM.0b013e3181f265ba
    Abstract
    OBJECTIVE: The antimetabolite drug, 5-fluorouracil, inhibits microbial growth. Coating of central venous catheters with 5-fluorouracil may reduce the risk of catheter infection. Our objective was to compare the safety and efficacy of central venous catheters externally coated with 5-fluorouracil with those coated with chlorhexidine and silver sulfadiazine. DESIGN: Prospective, single-blind, randomized, active-controlled, multicentered, noninferiority trial. SETTING: Twenty-five US medical center intensive care units. PATIENTS: A total of 960 adult patients requiring central venous catheterization for up to 28 days. INTERVENTIONS: Patients were randomized to receive a central venous catheter externally coated with either 5-fluorouracil (n = 480) or chlorhexidine and silver sulfadiazine (n = 480). MEASUREMENTS AND MAIN RESULTS: The primary antimicrobial outcome was a dichotomous measure (/= 15 colony-forming units) for catheter colonization determined by the roll plate method. Secondary antimicrobial outcomes included local site infection and catheter-related bloodstream infection. Central venous catheters coated with 5-fluorouracil were noninferior to chlorhexidine and silver sulfadiazine coated central venous catheters with respect to the incidence of catheter colonization (2.9% vs. 5.3%, respectively). Local site infection occurred in 1.4% of the 5-fluorouracil group and 0.9% of the chlorhexidine and silver sulfadiazine group. No episode of catheter-related bloodstream infection occurred in the 5-fluorouracil group, whereas two episodes were noted in the chlorhexidine and silver sulfadiazine group. Only Gram-positive organisms were cultured from 5-fluorouracil catheters, whereas Gram-positive bacteria, Gram-negative bacteria, and Candida were cultured from the chlorhexidine and silver sulfadiazine central venous catheters. Adverse events were comparable between the two central venous catheter coatings. CONCLUSIONS: Our results suggest that central venous catheters externally coated with 5-fluorouracil are a safe and effective alternative to catheters externally coated with chlorhexidine and silver sulfadiazine when used in critically ill patients.
    Source

    Crit Care Med. 2010 Nov;38(11):2095-102. Link to article on publisher's site

    DOI
    10.1097/CCM.0b013e3181f265ba
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/25774
    PubMed ID
    20711070
    Notes

    Khaldoun Faris, Wiley Hall, Alan Orquiola, Melissa O'Neill, and Jaclyn Longtine are coinvestigators from UMass Medical School in the 5-FU Study Group.

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    Link to Article in PubMed
    ae974a485f413a2113503eed53cd6c53
    10.1097/CCM.0b013e3181f265ba
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    • Thumbnail

      Modern trends in infection control practices in intensive care units

      Gandra, Sumanth; Ellison, Richard T. III (2014-11-12)
      Hospital-acquired infections (HAIs) are common in intensive care unit (ICU) patients and are associated with increased morbidity and mortality. There has been an increasing effort to prevent HAIs, and infection control practices are paramount in avoiding these complications. In the last several years, numerous developments have been seen in the infection prevention strategies in various health care settings. This article reviews the modern trends in infection control practices to prevent HAIs in ICUs with a focus on methods for monitoring hand hygiene, updates in isolation precautions, new methods for environmental cleaning, antimicrobial bathing, prevention of ventilator-associated pneumonia, central line-associated bloodstream infections, catheter-associated urinary tract infections, and Clostridium difficile infection.
    • Thumbnail

      Effect of a Multidisciplinary Team Approach to Eradicate Central Line Associated Blood-Stream Infections (CLABSI)

      Walz, J. Matthias; Ellison, Richard T. III; Flaherty, Helen; McIlwaine, John; Mack, Deborah Ann; Whyte, Kathleen; Landry, Karen; Baker, Stephen P.; Heard, Stephen O.; CCOC Research Group (2012-02-04)
      Introduction: CLABSI remains a significant problem in the intensive care unit. Hypothesis: A multimodal approach for the insertion and care of CVC will prevent CLABSI. Methods: A Critical Care Operations Committee was formed to transform care in 8 intensive care units (ICU) in an academic medical center in 9/2004. One goal was to reduce CLABSI. Using evidence based medicine, a clinical practice guideline was developed that incorporated the use of maximum barrier precautions, chlorhexidine skin preparation, avoidance of the femoral insertion site, dedicated catheter cart, a check list, the tracking of high risk CVC, anti-septic or antimicrobial impregnated catheters, a recommendation to use ultrasound guidance when inserting CVC in the internal jugular vein, daily determination of the need for the CVC and treatment of CLABSI as a critical event.CLABSI were adjudicated by the hospital epidemiologist and CVC days were tracked. Rates of CLABSI were followed from 9/2004 through 7/2011. The Spearman correlation coefficient was used for statistical evaluation. A p Results: CLABSI rates (per 1000 catheter-days) declined dramatically from 2004 to 2011 (p Conclusions: A multimodal approach to CVC insertion and care reduces CLABSI by over 90%. Our ultimate goal is the complete eradication of CRBSI in our institution.
    • Thumbnail

      The bundle "plus": the effect of a multidisciplinary team approach to eradicate central line-associated bloodstream infections

      Walz, J. Matthias; Ellison, Richard T. III; Mack, Deborah A.; Flaherty, Helen M.; McIlwaine, John K.; Whyte, Kathleen G.; Landry, Karen E.; Baker, Stephen P.; Heard, Stephen O. (2015-04-01)
      BACKGROUND: Central line-associated bloodstream infections (CLABSIs) have decreased significantly over the last decade. Further reductions in CLABSI rates should be possible. We describe a multidisciplinary approach to the reduction of CLABSIs. METHODS: This was an observational study of critically ill patients requiring central venous catheters in 8 intensive care units in a tertiary medical center. We implemented a catheter bundle that included hand hygiene, education of providers, chlorhexidine skin preparation, use of maximum barrier precautions, a dedicated line cart, checklist, avoidance of the femoral vein for catheter insertion, chlorhexidine-impregnated dressings, use of anti-infective catheters, and daily consideration of the need for the catheter. Additional measures included root cause analyses of all CLABSIs, creation of a best practice atlas for internal jugular catheters, and enhanced education on blood culture collection. Data were analyzed using the Poisson test and regression. RESULTS: CLABSI, catheter use, and microbiology were tracked from 2004 to 2012. There was a 92% reduction in CLABSIs (95% lower confidence limit: 67.4% reduction, P < 0.0001). Central venous catheter use decreased significantly from 2008 to 2012 (P = 0.032, -151 catheters per year, 95% confidence limits: -277 to -25), whereas peripherally inserted central catheter use increased (P = 0.005, 89 catheters per year, 95% confidence limits: 50 to 127). There was no apparent association between unit-specific Acute Physiology And Chronic Health Evaluation III/IV scores and CLABSI. Three units have not had a CLABSI in more than a year. The most common organism isolated was coagulase-negative staphylococcus. Since the implementation of minocycline/rifampin catheters, no cases of methicillin-resistant Staphylococcus aureus CLABSI have occurred. CONCLUSIONS: The implementation of a standard catheter bundle combined with chlorhexidine dressings, minocycline/rifampin catheters, and other behavioral changes was associated with a sustained reduction in CLABSIs.
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