CLABSI prevention and central venous catheter exchange

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“In the setting of SA-CLABSI, exchanging the CVC over guidewire with M/R-CVC could be an alternative to removing the CVC and reinserting another CVC at a different site and may be associated with a lower rate of overall mortality. Further large prospective randomized clinical trials are warranted.” Chaftari et al (2014).

Reference:

Chaftari, A.M., El Zakhem, A., Jamal, M.A., Jiang, Y., Hachem, R. and Raad, I. (2014) The Use of minocyclin-rifampin coated central venous catheters for exchange of catheters in the setting of staphylococcus aureus central line associated bloodstream infections. BMC Infectious Diseases. 14(1), p.518.

Abstract:

BACKGROUND: Central venous catheters (CVC) removal and reinsertion of a new CVC in the setting of central line associated bloodstream infections (CLABSI) is not always possible in septic patients. The purpose of this study was to evaluate the outcome of patients with Staphylococcus aureus-CLABSI (SA-CLABSI) who had their CVCs exchanged over guidewire for minocycline/ rifampin-coated (M/R)-CVC within seven days of bacteremia.

METHODS: Each case was matched with two control patients who had SA-CLABSI and had their CVC removed within seven days and two control patients who had their CVC retained beyond seen days. In addition, an in vitro model was developed for exchange of catheters.

RESULTS: We identified 40 patients with SA-CLABSI. Eight patients had their CVC exchanged over guidewire with M/R-CVC and were compared to 16 patients who had their CVC removed and 16 other patients who had their CVC retained. Patients who had their CVC exchanged over guidewire had a similar clinical response and relapse rates compared to patients whose CVC was removed or retained. However the rate of overall mortality was higher in patients who retained their CVC compared to those whose CVC was exchanged or removed (p = 0.034). The in vitro catheter exchange model showed that catheter exchange over guidewire using M/R-CVC completely prevented biofilm colonization compared to exchange using uncoated CVC (p < 0.0001).

CONCLUSIONS: In the setting of SA-CLABSI, exchanging the CVC over guidewire with M/R-CVC could be an alternative to removing the CVC and reinserting another CVC at a different site and may be associated with a lower rate of overall mortality. Further large prospective randomized clinical trials are warranted.

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