Four cases of anaphylaxis to chlorhexidine impregnated central venous catheters: a case cluster or the tip of the iceberg?

Jee, R.; Nel, L.; Gnanakumaran, G.; Williams, A.; Eren, Erdem

doi:10.1093/bja/aep248

Cited by 51 publications

(33 citation statements)

References 5 publications

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“…Chlorhexidine is widely used in the healthcare setting. As a consequence, there is a high risk of re‐exposure, and several case reports have described patients with immediate‐type chlorhexidine allergy, who were accidentally re‐exposed . In the current study, seven patients (35%) reported a total of nine re‐exposures in the healthcare setting, and the highest risk of re‐exposure seems to be in the perioperative setting, in urethral gels and in skin swabs.…”

Section: Discussionmentioning

confidence: 54%

Dynamics of plasma levels of specific IgE in chlorhexidine allergic patients with and without accidental re‐exposure

Opstrup

Poulsen

Malling

et al. 2016

Clin Experimental Allergy

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Time from reaction should be considered when interpreting specific IgE results. Specific IgE is >0.35 kUA/L in most patients at time of reaction but should be repeated after a few weeks/months if negative. The optimal sampling time seems to be >1 month and <4 months. A value <0.35 kUA/L neither excludes allergy nor implies loss of reactivity in previously sensitized patients. Re-exposures are common, often iatrogenic, and can cause a rebound in specific IgE.

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Section: Discussionmentioning

confidence: 54%

Dynamics of plasma levels of specific IgE in chlorhexidine allergic patients with and without accidental re‐exposure

Opstrup

Poulsen

Malling

et al. 2016

Clin Experimental Allergy

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“…Prolonged anti-infective activity provides improved efficacy in preventing infections (112). Although rare, anaphylaxis with the use of these chlorhexidine/silver sulfadiazine catheters has been observed (113–117). …”

Section: Antimicrobial/antiseptic Impregnated Catheters and Cuffsmentioning

confidence: 99%

Guidelines for the Prevention of Intravascular Catheter-related Infections: Recommendations Relevant to Interventional Radiology for Venous Catheter Placement and Maintenance

Miller

O’Grady

2012

Journal of Vascular and Interventional Radiology

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“…MSC is the lowest sub‐MIC concentration that may result in the selection of a resistant mutant in case of constant/chronical exposure . The released substances will also spread in the human body and may cause harm to human cells, resulting in, for example, hemolysis or inflammatory responses, and in extreme cases even lead to allergic reactions, including anaphylactic schock . Thus, a nonreleasing, durable coating has potential advantages over releasing coatings, regarding better safety profile, lower risk to develop resistance, as well as a more long‐lasting effect.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of central venous catheters coated with a noble metal alloy—A randomized clinical pilot study of coating durability, performance and tolerability

et al. 2017

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The use of Central Venous Catheters (CVCs) commonly results in complications. Coatings with silver or metal alloys can reduce the risk associated with the use of CVC. We have evaluated the durability of a noble metal coated CVC (the Bactiguard Infectious Protection, BIP CVC) and compared with an uncoated CVC for clinical tolerability (Adverse Events, AEs) and performance, in order to create a baseline for a large future study. Patients undergoing major surgery, randomised at a 2:1 ratio to BIP CVC (n = 22) or standard CVC (n = 12), were catheterized 9 ‐ 12 days, respectively. Adverse events, microbial colonization and metal release were measured. Findings: There were no AEs in the BIP CVC‐group, but 5 AEs occurred in 4 patients (1 patient had 2 AEs) in the standard CVC‐group, p = 0.011 (whereof 3 were catheter related). The BIP CVC showed an initial release of coating metals in blood (gold, silver and palladium), which rapidly decreased and were far below Permitted Paily Exposure (PDE) for chronical use. The levels of silver concentration were far below those needed to develop microbial resistance. The performance was equal, and there was no difference concerning microbial colonization, for the two CVCs. Conclusion: In this pilot study the BIP CVC had significantly lower AEs and showed a comparable performance to the standard CVC. The coating was durable throughout the study length (up to 16 days) and toxicological evaluation showed good safety margins. Larger studies are needed. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2337–2344, 2018.

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Four cases of anaphylaxis to chlorhexidine impregnated central venous catheters: a case cluster or the tip of the iceberg?

Cited by 51 publications

References 5 publications

Dynamics of plasma levels of specific IgE in chlorhexidine allergic patients with and without accidental re‐exposure

Dynamics of plasma levels of specific IgE in chlorhexidine allergic patients with and without accidental re‐exposure

Guidelines for the Prevention of Intravascular Catheter-related Infections: Recommendations Relevant to Interventional Radiology for Venous Catheter Placement and Maintenance

Evaluation of central venous catheters coated with a noble metal alloy—A randomized clinical pilot study of coating durability, performance and tolerability

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