Am Fam Physician. 2004;69(9):2211-2212
Critically ill patients often have high mortality rates when they develop nosocomial bloodstream infections. In addition, these infections have been shown to increase lengths of stay in intensive care units (ICUs) and to add substantially to the cost of care. One of the main sources of nosocomial bloodstream infections is intravascular catheters. A substantial number of nosocomial infections have been associated with catheter colonization, or the infections suggest that catheters are the source. Central venous catheters impregnated with minocycline and rifampin have been shown to reduce nosocomial bloodstream infections. Studies have shown that catheter-related infections were 12 times less likely to occur with these impregnated catheters. However, despite this reduction in infection incidence, the use of these catheters may result in an increase in multi-drug–resistant organisms. Hanna and colleagues assessed the impact of central venous catheters impregnated with minocycline and rifampin on nosocomial bloodstream infections in critically ill patients.
This two-year prospective surveillance study included patients who were admitted to surgical and medical ICUs at a cancer center. During the first year, central venous catheters without impregnated antibiotics were inserted; in the second year, patients were switched to catheters with minocycline and rifampin impregnated on the outside and the inside of the lumen. Standard sterile techniques were used during insertion, and care of the catheter site was performed per protocol. The decision to remove and culture the catheter was made by each patient’s primary care physician. Outcome measures were nosocomial bloodstream infections, including vancomycin-resistant enterococcus (VRE); catheter-related infections; duration of ICU and hospital stays; and mortality in the ICU related to bloodstream infections.
During the first year, 1,781 patients were admitted to the two ICUs, while 2,349 patients were admitted during the second year. The demographics of the groups in years 1 and 2 were not significantly different. The rate of nosocomial bloodstream infections in the medical and surgical ICUs dropped significantly during year 2 of the study compared with year 1. In addition, the number of nosocomial VRE infections, the length of ICU stay, and the length of hospital stay decreased significantly after the use of antibiotic-impregnated catheters was introduced. The rate of catheter-related infections also decreased in year 2 of the study compared with year 1. Cost analysis revealed that implementation of antibiotic-impregnated catheters saved the hospital $1,450,000 during the fiscal year.
The authors conclude that the use of antibiotic-impregnated central venous catheters in medical and surgical ICUs is associated with a significant decrease in nosocomial bloodstream infections. In addition, this intervention reduces the development of VRE bacteremia, catheter-related infections, and length of ICU and hospital stays.