Combined minocycline, rifampin and chlorhexidine treated PICCs

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Intravenous literature: Raad, I., Mohamed, J.A., Reitzel, R.A., Jiang, Y., Raad, S., Al Shuaibi, M., Chaftari, A.M. and Hachem, R.Y. (2011) Improved Antibiotic Impregnated Catheters with Extended Spectrum Activity Against Resistant Bacteria and Fungi. Antimicrobial Agents and Chemotherapy. Nov 28. [Epub ahead of print].

Abstract:

Minocycline/rifampin (M/R) central venous catheters (M/R CVC) have been shown to be efficacious in reducing catheter-related bloodstream infections (CRBSI) and inhibiting the biofilm adherence of resistant Gram-positive and Gram-negative pathogens with the exception of Pseudomonas aeruginosa and Candida. To expand the spectrum of antimicrobial activity, a novel second generation M/R-catheter was developed by adding chlorhexidine (CHX-M/R). CVC and peripherally inserted central catheters (PICC) were impregnated with CHX-M/R and compared with first generation M/R catheters, chlorhexidine/silver sulfadiazine treated CVCs (CHX/SS-CVC), chlorhexidine treated PICCs and uncoated catheters. A biofilm catheter colonization model was used to assess the efficacy of catheters against methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus faecium (VRE), P. aeruginosa, Candida albicans and Candida glabrata. CHX-M/R impregnated CVC was the only antimicrobial catheters that completely inhibited the biofilm colonization of all resistant bacterial and fungal organisms tested at all time intervals and were significantly superior to uncoated catheters (all p values ≤ 0.003). Furthermore, CHX-M/R coated CVC had a significantly more effective and prolonged antimicrobial activity up to 3 weeks against MRSA, and P. aeruginosa compared to M/R, CHX/SS and uncoated CVC (p < 0.0001). Similarly, CHX-M/R coated PICC was also superior to M/R coated and chlorhexidine PICC in preventing biofilm of MRSA, VRE, P. aeruginosa and Candida species (all p-values= 0.003). Our study shows that novel CHX-M/R catheters have unique properties in completely inhibiting biofilm colonization of MRSA, VRE, and P. aeruginosa and fungi in a manner superior to the M/R and chlorhexidine treated catheters.

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