This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (176)  • Contact me when this article is cited  Related Content  • Related letter  • Related article  • Similar articles in JAMA  Topic Collections  • Evidence-Based Medicine  • Review  • Cardiac Diagnostic Tests  • Alert me on articles by topic

A Meta-analysis

David L. Veenstra, PharmD, PhD; Sanjay Saint, MD, MPH; Somnath Saha, MD, MPH; Thomas Lumley, PhD; Sean D. Sullivan, PhD

JAMA. 1999;281:261-267.

Context  Central venous catheters impregnated with chlorhexidine and silver sulfadiazine have recently been introduced for the prevention of catheter-related infections. However, there remains some uncertainty regarding the efficacy of these catheters because of conflicting reports in the literature.

Objective  To evaluate the efficacy of chlorhexidine–silver sulfadiazine–impregnated central venous catheters in the prevention of catheter-related bloodstream infection.

Data Sources  Studies identified from a computerized search of the MEDLINE database from January 1966 to January 1998, reference lists of identified articles, and queries of principal investigators and the catheter manufacturer.

Study Selection  Randomized trials comparing chlorhexidine–silver sulfadiazine–impregnated central venous catheters with nonimpregnated catheters were included. The outcomes assessed were catheter colonization and catheter-related bloodstream infection confirmed by catheter culture.

Data Extraction  Twelve studies met the inclusion criteria for catheter colonization and included a total of 2611 catheters. Eleven studies with a total of 2603 catheters met the inclusion criteria for catheter-related bloodstream infection. Most patients in these studies were from groups considered to be at high risk for catheter-related infections. Summary statistics were calculated using Mantel-Haenszel methods under a fixed-effects model.

Data Synthesis  The summary odds ratio for catheter colonization was 0.44 (95% confidence interval [CI], 0.36-0.54; P<.001), indicating a significant decrease in catheter colonization associated with impregnated catheters. The studies examining the outcome of primary interest, catheter-related bloodstream infection, had a summary odds ratio of 0.56 (95% CI, 0.37-0.84; P=.005).

Conclusions  Central venous catheters impregnated with a combination of chlorhexidine and silver sulfadiazine appear to be effective in reducing the incidence of both catheter colonization and catheter-related bloodstream infection in patients at high risk for catheter-related infections.

Author Affiliations: Departments of Pharmacy (Drs Veenstra and Sullivan), Medicine (Drs Saint and Saha), Biostatistics (Dr Lumley), and Health Services (Dr Sullivan), University of Washington, Seattle. Dr Saint is now with the University of Michigan Medical Center, Ann Arbor.

RELATED LETTER

Central Venous Catheters and Bloodstream Infection
Jörg Schierholz, Ralph Lefering, Edmund Neugebauer, Joseph Beuth, Dietmar-Pierre König, Gerhard Pulverer, Evelina Tacconelli, Mario Tumbarello, Roberto Cauda, David L. Veenstra, Sean D. Sullivan, and Sanjay Saint
JAMA. 2000;283(4):477-479.
EXTRACT | FULL TEXT  

RELATED ARTICLE

January 20, 1999
JAMA. 1999;281(3):293-294.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Anti-adherence activity and antimicrobial durability of anti-infective-coated catheters against multidrug-resistant bacteria
Raad et al.
J Antimicrob Chemother 2008;62:746-750.
ABSTRACT | FULL TEXT  

Patient Satisfaction and Sustained Outcomes of Drug Abuse Treatment
Zhiwei Zhang et al.
J Health Psychol 2008;13:388-400.
ABSTRACT  

Reasons for Explantation of Totally Implantable Access Ports: A Multivariate Analysis of 385 Consecutive Patients
Fischer et al.
Ann. Surg. Oncol. 2008;15:1124-1129.
ABSTRACT | FULL TEXT  

Thrombotic and infectious complications of central venous catheters in patients with hematological malignancies
Boersma et al.
Ann Oncol 2008;19:433-442.
ABSTRACT | FULL TEXT  

Prevention of Coagulase-Negative Staphylococcal Central Venous Catheter-Related Infection Using Urokinase Rinses: A Randomized Double-Blind Controlled Trial in Patients With Hematologic Malignancies
van Rooden et al.
JCO 2008;26:428-433.
ABSTRACT | FULL TEXT  

Inhibition of Staphylococcus Epidermidis Colonization with Fusidic Acid-Impregnated Catheters
Agalar et al.
Journal of Bioactive and Compatible Polymers 2007;22:160-173.
ABSTRACT  

Using Bacteriophages To Reduce Formation of Catheter-Associated Biofilms by Staphylococcus epidermidis.
Curtin and Donlan
Antimicrob. Agents Chemother. 2006;50:1268-1275.
ABSTRACT | FULL TEXT  

Twenty-five Years of Advances in Vascular Access: Bridging Research to Clinical Practice
Krzywda and Andris
Nutr Clin Pract 2005;20:597-606.
ABSTRACT | FULL TEXT  

Parenteral Nutrition as a Risk Factor for Central Venous Catheter-Related Infection
Beghetto et al.
JPEN J Parenter Enteral Nutr 2005;29:367-373.
ABSTRACT | FULL TEXT  

Bedside Ultrasonography in the ICU: Part 2
Beaulieu and Marik
Chest 2005;128:1766-1781.
ABSTRACT | FULL TEXT  

Infection Control in Intensive Care Units
Mohr et al.
Journal of Pharmacy Practice 2005;18:84-90.
ABSTRACT  

Catheter-Related Bloodstream Infections in the Intensive Care Unit Population
Haase et al.
Journal of Pharmacy Practice 2005;18:42-52.
ABSTRACT  

Relevance of the Agency for Healthcare Research and Quality Patient Safety Indicators for Children's Hospitals
Sedman et al.
Pediatrics 2005;115:135-145.
ABSTRACT | FULL TEXT  

Reduced colonization and infection with miconazole-rifampicin modified central venous catheters: a randomized controlled clinical trial
Yucel et al.
J Antimicrob Chemother 2004;54:1109-1115.
ABSTRACT | FULL TEXT  

Colonization and Bloodstream Infection with Single- Versus Multi-Lumen Central Venous Catheters: A Quantitative Systematic Review
Zurcher et al.
Anesth. Analg. 2004;99:177-182.
ABSTRACT | FULL TEXT  

Primary Care Pediatrics: 2004 and Beyond
Cheng
Pediatrics 2004;113:1802-1809.
FULL TEXT  

Long-term central venous access
Galloway and Bodenham
Br J Anaesth 2004;92:722-734.
ABSTRACT | FULL TEXT  

Catheter-Associated Infections: Pathogenesis Affects Prevention
Trautner and Darouiche
Arch Intern Med 2004;164:842-850.
ABSTRACT | FULL TEXT  

Prevention of catheter related bloodstream infection by silver iontophoretic central venous catheters: a randomised controlled trial
Bong et al.
J. Clin. Pathol. 2003;56:731-735.
ABSTRACT | FULL TEXT  

Comparison of microbial adherence to antiseptic and antibiotic central venous catheters using a novel agar subcutaneous infection model
Gaonkar and Modak
J Antimicrob Chemother 2003;52:389-396.
ABSTRACT | FULL TEXT  

Prophylactic Efficacy of Topical Temporin A and RNAIII-Inhibiting Peptide in a Subcutaneous Rat Pouch Model of Graft Infection Attributable to Staphylococci With Intermediate Resistance to Glycopeptides
Cirioni et al.
Circulation 2003;108:767-771.
ABSTRACT | FULL TEXT  

Risk of Colonization of Central Venous Catheters: Catheters for Total Parenteral Nutrition Vs Other Catheters
Dimick et al.
Am J Crit Care 2003;12:328-335.
ABSTRACT | FULL TEXT  

Preventing Complications of Central Venous Catheterization
McGee and Gould
NEJM 2003;348:1123-1133.
FULL TEXT  

Hemodialysis Infection Prevention with Polysporin Ointment
Lok et al.
J. Am. Soc. Nephrol. 2003;14:169-179.
ABSTRACT | FULL TEXT  

Guidelines for the Prevention of Intravascular Catheter-Related Infections
O'Grady et al.
Pediatrics 2002;110:e51-51.
ABSTRACT | FULL TEXT  

Diagnosis, prevention, and management of catheter related bloodstream infection during long term parenteral nutrition
Hodge and Puntis
Arch. Dis. Child. Fetal Neonatal Ed. 2002;87:F21-24.
FULL TEXT  

Chlorhexidine Compared with Povidone-Iodine Solution for Vascular Catheter-Site Care: A Meta-Analysis
Chaiyakunapruk et al.
ANN INTERN MED 2002;136:792-801.
ABSTRACT | FULL TEXT  

The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and Candida
Safdar and Maki
ANN INTERN MED 2002;136:834-844.
ABSTRACT | FULL TEXT  

Enhancing the Safety of Critically Ill Patients by Reducing Urinary and Central Venous Catheter-related Infections
Saint et al.
Am. J. Respir. Crit. Care Med. 2002;165:1475-1479.
FULL TEXT  

Intravascular Catheter-Related Infections: New Horizons and Recent Advances
Raad and Hanna
Arch Intern Med 2002;162:871-878.
ABSTRACT | FULL TEXT  

Biofilms: Survival Mechanisms of Clinically Relevant Microorganisms
Donlan and Costerton
Clin. Microbiol. Rev. 2002;15:167-193.
ABSTRACT | FULL TEXT  

Infection Control in the ICU
Eggimann and Pittet
Chest 2001;120:2059-2093.
ABSTRACT | FULL TEXT  

Managing bloodstream infections associated with intravascular catheters
DTB 2001;39:75-80.
ABSTRACT | FULL TEXT  

Top Ten List in Sepsis
Sessler
Chest 2001;120:1390-1393.
FULL TEXT  

Prolonged Antimicrobial Activity of a Catheter Containing Chlorhexidine-Silver Sulfadiazine Extends Protection against Catheter Infections In Vivo
Bassetti et al.
Antimicrob. Agents Chemother. 2001;45:1535-1538.
ABSTRACT | FULL TEXT  

A New {beta}A1-Crystallin Splice Junction Mutation in Autosomal Dominant Cataract
Bateman et al.
IOVS 2000;41:3278-3285.
ABSTRACT | FULL TEXT  

The antimicrobial efficacy of a new central venous catheter with long-term broad-spectrum activity
Schierholz et al.
J Antimicrob Chemother 2000;46:45-50.
ABSTRACT | FULL TEXT  

Prevention of Intravascular Catheter-Related Infections
Mermel
ANN INTERN MED 2000;132:391-402.
ABSTRACT | FULL TEXT  

Central Venous Catheters and Bloodstream Infection
Schierholz et al.
JAMA 2000;283:477-479.
FULL TEXT  

Cost-Effectiveness of Antiseptic-Impregnated Central Venous Catheters for the Prevention of Catheter-Related Bloodstream Infection
Veenstra et al.
JAMA 1999;282:554-560.
ABSTRACT | FULL TEXT  

Antiseptic-Impregnated Central Venous Catheters Reduce Risk for Infection
JWatch Emergency Med. 1999;1999:2-2.
FULL TEXT