Novel approach using antimicrobial catheters to improve the management of central line‐associated bloodstream infections in cancer patients

Abstract

BACKGROUND: Central venous catheter (CVC) removal has often been recommended for the treatment of central line‐associated bloodstream infections (CLABSIs). However, CVC removal is not always practical in patients with cancer, and changing CVCs with noncoated CVCs over guidewire may result in cross‐infection of the new CVC. Therefore, the current matched retrospective cohort study was conducted to evaluate the effectiveness of exchanging infected CVCs for minocycline‐ and rifampin (MR)‐coated CVCs in cancer patients with CLABSIs. METHODS: The authors identified all cancer patients with CLABSIs who had undergone either CVC exchange with MR‐coated CVCs or CVC removal at the study institution. All patients were treated with appropriate systemic antibiotics. The exchange group was matched in a 1:2 ratio with the removal group by organism, underlying disease, and neutropenia. The demographics, clinical characteristics, and outcome were compared. Overall response was defined as the resolution of clinical signs and symptoms and eradication of bacteremia within 72 hours after CVC exchange or removal, without disease recurrence or infection‐related death. RESULTS: A total of 120 cancer patients were included (40 in the exchange group and 80 in the removal group). Overall response rates were 95% in the exchange group and 76% in the removal group (P = .011). No disease recurrences or infection‐related deaths occurred in the exchange group; 8 disease recurrences or deaths (11%) occurred in the removal group (P = .05). Patients in the exchange group also experienced lower rates of mechanical failure (3% vs 15%; P = .049). CONCLUSIONS: Exchanging CVCs for MR‐coated CVCs in cancer patients with CLABSIs may improve the overall response rate and decrease the risk of mechanical failure, disease recurrence, and infection‐related mortality. Cancer 2011. © 2010 American Cancer Society.

Prevention of Transmission of Multidrug-Resistant Organisms during Catheter Exchange using Antimicrobial Catheters

“…The results from the in vitro exchange model for M/R CVCs were consistent with those of a recent clinical study from our center showing that the exchange of culprit CVCs for new M/R CVCs in the setting of CLABSI was useful in improving the overall response rate, decreasing the risk of mechanical failure, and decreasing disease recurrence (27). Another clinical study from our group revealed that exchanging colonized CVCs over guide wires for M/R CVCs was an effective alternative to removing and inserting new CVCs at a new vascular site in the setting of S. aureus infection and CLABSI (28; A. M. Chaftari and A. El Zakhem, submitted for publication).…”

Antifungal Lock Therapy

“…Recent clinical epidemiology studies have reported that the rates of immediate complications for catheter insertions range from 7.5% in hematology patients to 7.7% in general hospital patients when performed by a dedicated central venous catheter (CVC) placement service using ultrasound guidance or 29.4% without ultrasound guidance (3,4). The role of catheter exchange over a guidewire, which might be of benefit in some situations due to bacterial CRBSIs (5), is undefined in CR-BSIs caused by Candida (6).…”

Reply to letter on our article: Lorente L, Lecuona M, Jiménez A, Raja L, Cabrera J, Gonzalez O, et al. Chlorhexidine-silver sulfadiazine- or rifampicinmiconazole-impregnated venous catheters decrease the risk of catheter-related bloodstream infection similarly. Am J Infect Control. 2015 Sep 24. pii:S0196-6553(15)00931-1. doi: 10.1016/j.ajic.2015.08.014

“…In addition, the authors of the letter propose another novel potential indication for the use of impregnated catheters; that is, in patients with documented CRBSI whose CVC must be removed, according the results of Chaftari and colleagues. 5,6 Those studies found a similar clinical response and relapse rate between patients who had a CVC exchanged over guidewire for minocycline/rifampincoated CVCs and patients in whom the CVC was removed. In addition, the in vitro catheter exchange model revealed that catheter exchange over guidewire using minocycline/rifampin-coated CVCs completely prevented biofilm colonization compared with exchange using uncoated CVCs.…”