Effectiveness of Antimicrobial Coated Catheters for Prevention of Blood Stream Infection in a Trauma Patient Population

Abstract

Background: Clinical leaders are faced with making the decision to utilize products with varied designs without enough evidence to make an informed decision. An example of this problem is the decision regarding whether to change from uncoated to antimicrobial or antibiotic catheters to prevent Central Line Associated Blood Stream Infection (CLABSI). Purpose: This study compares the effectiveness of three types of central venous catheters (CVC): (1) non-coated (2) antimicrobial (silver) and (3) antibiotic coated. The four CLABSI outcome measures were: (1) CLABSI rate per 1,000 catheter days, (2) gram positive organism cultures per total admissions (3) gram negative organism cultures per total admissions, (4) yeast organism cultures per total admissions. Methods: This retrospective study assessed the comparative effectiveness of CVCs in a trauma hospital population (n = 10,680) admitted between July 01, 2006 and June 30th, 2011. Monthly data were obtained for the time periods when each catheter type was purchased. Linear mixed models (LMMs), with data nested within units, were used to examine differences among the three periods in BSI rates and frequency of organism type. Results: Antibiotic coated catheters reduced BSI rates (beta=4.054, p <0.001) and gram negative organisms (beta=6.608, p <0.001). Silver impregnated catheters reduced gram negative organisms (beta= 3.194, p=0.009) compared with uncoated catheters. Conclusion: Further improvement in CVC technology is required to be effective for broad spectrum of organisms. Large prospective randomized clinical trials are needed to determine the effectiveness of devices to inform purchasing decisions.