Antimicrobials: Healthcare's Silver Bullet Against HAIs?

Studies by Maki and Raad are among the most-cited sources for data on the impact antimicrobial-treated catheters can have on catheter-related bloodstream infections (CRBSIs). The studies evaluated catheter colonization and microbial colonization of the skin at the catheter insertion site, and assessed the overall impact of impregnated catheters in reducing CRBSIs. Maki et al. (1997) showed use of central venous catheters coated with chlorhexidine-silver sulfadiazine was associated with a 44 percent reduction in catheter colonization (13.5 colonized catheters per 100 catheters versus 24.1 colonized catheters per 100 catheters; and a 79 percent reduction in the rate of catheter-related bloodstream infections (1.0 infection per 100 catheters versus 4.6 infections per 100 catheters. Raad et al. (1997) showed use of central venous catheters coated with minocycline and rifampin was also associated with significant reductions in the rates of catheter colonization and CRBSIs (0 bloodstream infections per 1,000 catheter-days versus 7.34 bloodstream infections per 1,000 catheter days).

“An important finding of these two studies was that none of the impregnated catheters was associated with adverse events (such as hypersensitivity reaction or toxicity) or infections caused by resistant pathogens,” observe Pearson and Abrutyn (1997). “However, additional evaluation seems warranted because catheters were in situ for an average of only six days and assessment for rare or uncommon events requires more observations than reported in this study. Emergence of resistant bloodstream pathogens and adverse reactions are two important concerns that still need additional evaluation.”

Pearson and Abrutyn (1997) advise, “In deciding whether to use impregnated central venous catheters in an institution, physicians may be guided by the characteristics of the patient population, the institutional rates of central venous catheter-related infection, and the skill of the personnel at the institution. The studies by Maki and Raad suggest that impregnated catheters, although not a magic bullet, may be an important advance in reducing the rate of central venous catheter-related infections, particularly in critically ill patients with multi-lumen catheters for the short term and in settings in which rates of central venous catheter-related bloodstream infection remain high despite full adherence to proven infection control measures.”