Antimicrobial durability and rare ultrastructural colonization of indwelling central catheters coated with minocycline and rifampin

Raad, Issam; Darouiche, Rabih O.; Hachem, Ray; Abi-Said, Dima; Safar, Hossam; Darnule, Tukaram; Mansouri, Mohammed; Morck, Douglas W.

doi:10.1097/00003246-199802000-00015

Cited by 94 publications

(44 citation statements)

References 22 publications

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“…27 Catheters treated with minocycline and rifampin may have antimicrobial activity extending up to 2 and possibly up to 4 to 6 weeks. 25 This inconsistency may be interpreted as evidence of specific antibiotic activities. Further randomized trials are needed to establish the effect of different antibiotic coating methods on the long-term anti-infective efficacy of CVCs.…”

Section: Discussionmentioning

confidence: 99%

“…50 There was no evidence for time dependency of antibiotic-coated devices because no trials reporting on longer average insertion times could be retrieved. If the antimicrobial efficacy of antibiotic-coated catheters should indeed extend to 2 to 4 weeks, 13,25 an exchange of them after 7 days might not be necessary. However, this needs to be confirmed in randomized, controlled trials.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-seven were considered for inclusion and 4 were subsequently excluded due to the following: one had an inadequate control group 22 ; one used historical controls 23 ; one had inadequate endpoints 24 ; and one 25 described the same cohort reported in a previous article. 26 Finally, 23 trials 8 ' 9,2646 published between 1988 and 1999 including data on 4,660 catheters (2,319 anti-infective and 2,341 control) were analyzed (Table 1).…”

Section: Trial Characteristicsmentioning

confidence: 99%

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Prevention of Bloodstream Infections With Central Venous Catheters Treated With Anti-Infective Agents Depends on Catheter Type and Insertion Time: Evidence From a Meta-Analysis

Walder

Pittet

Tramèr

2002

Infect. Control Hosp. Epidemiol.

142

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OBJECTIVE: To test the evidence that the risk of infection related to central venous catheters (CVCs) is decreased by antiinfective coating or cuffing.DESIGN: Systematic review of randomized, controlled trials comparing anti-infective with inactive (control) CVCs.INTERVENTIONS: Average insertion times were taken as a measurement of the length of insertion. Dichotomous data were combined using a fixed effect model and expressed as odds ratio (OR) with 95% confidence interval (CI 95 ).RESULTS: Two trials on antibiotic coating (343 CVCs) had an average insertion time of 6 days; the risk of BSI decreased from 5.1% with control to 0% with anti-infective catheters. There were no trials with longer average insertion times. In three trials on silver collagen cuffs (422 CVCs), the average insertion time ranged from 5 to 8.2 days (median, 7 days); the risk of BSI was 5.6% with control and 3.2% with anti-infective catheters. In another trial on silver collagen cuffs (101 CVCs), the average insertion time was 38 days; the risk of BSI was 3.7% with control and 4.3% with anti-infective catheters. In five trials on chlorhexidine-silver sulfadiazine coating (1,269 CVCs), the average insertion time ranged from 5.2 to 7.5 days (median, 6 days); the risk of BSI decreased from 4.1% with control to 1. 9% with anti-infective catheters. In five additional trials on chlorhexidine-silver sulfadiazine coating (1,544 CVCs), the average insertion time ranged from 7.8 to 20 days (median, 12 days); the risk of BSI was 4.5% with control and 4.2% with anti-infective catheters.CONCLUSIONS: Antibiotic and chlorhexidine-silver sulfadiazine coatings are anti-infective for short (approximately 1 week) insertion times. For longer insertion times, there are no data on antibiotic coating, and there is evidence of lack of effect for chlorhexidine-silver sulfadiazine coating. For silver-impregnated collagen cuffs, there is evidence of lack of effect for both short-and long-term insertion (Infect Control Hosp Epidemiol 2002;23:748-756).Central venous catheters (CVCs) are commonly used for hemodynamic monitoring, administration of medication, and parenteral nutrition. The most frequently reported problems are insertion complications, occlusion of the catheter, vascular thrombosis, and catheter-related infections.1 Infection may be local or systemic, including thrombophlebitis, bloodstream infection (BSI), endocarditis, and metastatic distribution (eg, osteomyelitis, endophthalmitis, or arthritis).2,3 CVC-related bacteremia is a major cause of nosocomial BSI, 4,5 with a reported incidence of approximately 5%. 6 The consequences of these infections, in terms of morbidity, mortality, and additional healthcare costs, are of major importance. A novel technologic approach to reduce CVC-related infection is the impregnation of catheters with antiseptic or antimicrobial agents, but clinical trials to assess the efficacy of these agents have produced inconsistent results. 8,9 Guidelines for the prevention of intravascular device-related infections publishe...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Trial Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Prevention of Bloodstream Infections With Central Venous Catheters Treated With Anti-Infective Agents Depends on Catheter Type and Insertion Time: Evidence From a Meta-Analysis

Walder

Pittet

Tramèr

2002

Infect. Control Hosp. Epidemiol.

142

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“…A biofilm-infected implant often must be removed and replaced, placing the patient at increased risk for complications due to these additional procedures (5,32). Current antimicrobial therapies for biofilms have largely proven unsuccessful (15), and the exact explanation for these treatment failures is still unclear (9).…”

Section: Staphylococcal Infections Of Both Staphylococcus Aureus Andmentioning

confidence: 99%

“…Lysostaphin bridges this twostep process by both disrupting the S. aureus and S. epidermidis biofilms and killing the released bacteria. It has been shown that coating medical implants with antimicrobials may effectively prevent the initial adherence of staphylococcal biofilms to the implants (29,32,37). Coating biomedical materials with lysostaphin may also prove successful in preventing early adherence of staphylococci to the implants, thus averting biofilm formation.…”

mentioning

confidence: 99%

Lysostaphin Disrupts Staphylococcus aureus and Staphylococcus epidermidis Biofilms on Artificial Surfaces

Wu¹,

Kusuma²,

Mond³

et al. 2003

Antimicrob Agents Chemother

267

169

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Staphylococci often form biofilms, sessile communities of microcolonies encased in an extracellular matrix that adhere to biomedical implants or damaged tissue. Infections associated with biofilms are difficult to treat, and it is estimated that sessile bacteria in biofilms are 1,000 to 1,500 times more resistant to antibiotics than their planktonic counterparts. This antibiotic resistance of biofilms often leads to the failure of conventional antibiotic therapy and necessitates the removal of infected devices. Lysostaphin is a glycylglycine endopeptidase which specifically cleaves the pentaglycine cross bridges found in the staphylococcal peptidoglycan. Lysostaphin kills Staphylococcus aureus within minutes (MIC at which 90% of the strains are inhibited [MIC 90 ], 0.001 to 0.064 g/ml) and is also effective against Staphylococcus epidermidis at higher concentrations (MIC 90 , 12.5 to 64 g/ml). The activity of lysostaphin against staphylococci present in biofilms compared to those of other antibiotics was, however, never explored. Surprisingly, lysostaphin not only killed S. aureus in biofilms but also disrupted the extracellular matrix of S. aureus biofilms in vitro on plastic and glass surfaces at concentrations as low as 1 g/ml. Scanning electron microscopy confirmed that lysostaphin eradicated both the sessile cells and the extracellular matrix of the biofilm. This disruption of S. aureus biofilms was specific for lysostaphin-sensitive S. aureus, as biofilms of lysostaphin-resistant S. aureus were not affected. High concentrations of oxacillin (400 g/ml), vancomycin (800 g/ml), and clindamycin (800 g/ml) had no effect on the established S. aureus biofilms in this system, even after 24 h. Higher concentrations of lysostaphin also disrupted S. epidermidis biofilms.

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Catheter-Associated Infections

Trautner

Darouiche²

2004

Arch Intern Med

Self Cite

253

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Antimicrobial durability and rare ultrastructural colonization of indwelling central catheters coated with minocycline and rifampin

Abstract: Coating catheters with minocycline and rifampin inhibits ultrastructural colonization of indwelling catheters and maintains effective antimicrobial activity for at least 2 wks.

Cited by 94 publications

References 22 publications

Prevention of Bloodstream Infections With Central Venous Catheters Treated With Anti-Infective Agents Depends on Catheter Type and Insertion Time: Evidence From a Meta-Analysis

Prevention of Bloodstream Infections With Central Venous Catheters Treated With Anti-Infective Agents Depends on Catheter Type and Insertion Time: Evidence From a Meta-Analysis

Lysostaphin Disrupts Staphylococcus aureus and Staphylococcus epidermidis Biofilms on Artificial Surfaces

Catheter-Associated Infections

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