Patients with central venous catheters are at increased risk for nosocomial bloodstream infections that often result in increased hospital stays, medical costs and, ultimately, mortality. Strategies to prevent infection include aseptic insertion technique, proper catheter care and, more recently, use of catheters impregnated with the antiseptic chlorhexi-dine-silver sulfadiazine. These catheters have been shown to decrease catheter colonization, but their effectiveness in reducing the number of catheter-related bloodstream infections (CR-BSI) is not as well documented. Veenstra and colleagues conducted a meta-analysis of randomized, controlled clinical trials from 1966 to 1998 to evaluate the effectiveness of catheters impregnated with chlorhexidine-silver sulfadiazine in preventing catheter colonization and CR-BSI.
To be included in the meta-analysis, studies had to compare the effectiveness of chlorhexidine-silver sulfadiazine–impregnated central venous catheters with nonimpregnated catheters in preventing colonization and CR-BSI. Twelve studies were available for analysis of catheter colonization, and 11 studies were available for evaluation of CR-BSI.
Most of the patients evaluated were at high risk for catheter infection, with approximately one third hospitalized in an intensive care unit and the rest in other hospital settings. The average duration of catheter placement was five to 11 days. The risk of catheter colonization and CR-BSI was decreased in patients with medication-impregnated catheters compared with patients using nonimpregnated catheters. However, the evidence for preventing colonization was much stronger than that for preventing CR-BSI.
The authors conclude that catheters impregnated with chlorhexidine-silver sulfadiazine reduce the risk of CR-BSI by about 40 percent in high-risk populations that require short-term, multilumen central venous catheters. Use of medication-impregnated catheters in these patients may decrease the overall incidence and ultimately the medical costs of catheter-related bloodstream infections. In rare instances, hypersensitivity reactions to chlorhexidine have been reported; these require further study.