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Correspondence and Brief Communications |

A Randomized Trial of an Antibiotic- and Antiseptic-Coated Central Venous Catheter in the Prevention of Catheter-Related Infections

Alfons Bach, MD
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Copyright 1998 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.

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Arch Surg. 1998;133(9):1022-1022. doi:10.1001/archsurg.133.9.1022
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I read with interest the study by Tennenberg et al1 demonstrating that antiseptic-impregnated catheters reduce the risk of catheter-related infection. However, these results may be flawed because the potential impact of residual anti-infective compounds from the coated catheter on the subsequent microbiologic culture was not discussed.

For example, Schmitt et al2 demonstrated in an in vitro study that antiseptic compounds elute from catheters during culturing processes. Their findings show that it is critical for all culture techniques to include inhibitors of the antiseptic catheter compounds. Results of a previous study employing inhibitors3 to examine the bacterial colonization on 116 antiseptic-bonded and 117 control catheters showed that all antiseptic catheters retained antibacterial activity in patients for at least 5 days, and some of them for up to 20 days. These findings and the recent report by Maki et al4 demonstrate a long-lasting effect of antiseptic compounds on impregnated catheters. Because these antiseptic compounds may be transferred into the culture media, falsely low bacterial counts may have occurred if Tennenberg et al1 did not add inhibitors to their culture media.

In conclusion, the failure to employ appropriate techniques in analyzing bacterial colonization of catheters containing anti-infective compounds could have led to a considerable underestimation of the magnitude of bacterial catheter colonization.

REFERENCES

Tennenberg  S, Lieser  M, McCurdy  B.  et al.  A prospective randomized trial of an antibiotic- and antiseptic-coated central venous catheter in the prevention of catheter-related infections. Arch Surg. 1997;1321348- 1351
Schmitt  SK, Knapp  C, Hall  GS, Longworth  DL, McMahon  JT, Washington  JA. Impact of chlorhexidine-silver sulfadiazine-impregnated central venous catheters on the in vitro quantitation of catheter-associated bacteria. J Clin Microbiol. 1996;34508- 511
Bach  A, Schmidt  H, Böttiger  B.  et al.  Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J Antimicrob Chemother. 1996;37315- 322
Maki  DG, Stolz  SM, Wheeler  S, Mermel  LO. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. Ann Intern Med. 1997;127257- 266

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Tennenberg  S, Lieser  M, McCurdy  B.  et al.  A prospective randomized trial of an antibiotic- and antiseptic-coated central venous catheter in the prevention of catheter-related infections. Arch Surg. 1997;1321348- 1351
Schmitt  SK, Knapp  C, Hall  GS, Longworth  DL, McMahon  JT, Washington  JA. Impact of chlorhexidine-silver sulfadiazine-impregnated central venous catheters on the in vitro quantitation of catheter-associated bacteria. J Clin Microbiol. 1996;34508- 511
Bach  A, Schmidt  H, Böttiger  B.  et al.  Retention of antibacterial activity and bacterial colonization of antiseptic-bonded central venous catheters. J Antimicrob Chemother. 1996;37315- 322
Maki  DG, Stolz  SM, Wheeler  S, Mermel  LO. Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. Ann Intern Med. 1997;127257- 266

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