The Central Venous Catheter-related Infection of Chlorhexidine-silver Sulfadiazine Coated Catheters in Medical ICU / 결핵및호흡기질환

ABSTRACT

BACKGROUND: Central venous catheters(CVCs) area major source of nosocomial infection. Chlorhexidine-silver sulfadiazine coated catheters (CHSS) were developed to reduce the rate of CVC infection. However, the clinical effectiveness of CHSS in comparison wth non-coated catheter (NCC) remains to be evaluated. METHOD: From January 2004 to December 2004 in medical intensive care unit (ICU) of Asan Medical Center, CVCs were inserted in 446 cases. We retrospectively analyzed characteristics of patients and catheterization,the catheter- related infection rate and colonization, microbiologic findings, and insertion sites (subclavian, jugular, femoral) according to the type of inserted CVCs (NCC 187 cases, CHSS 259 cases). Catheter related infection is defined as catheter related bacteremia and catheter related non-bacteremic sepsis. RESULTS: 1) The mean age of the patients in each group was 62+/-16 years, 63+/-15 years (p=0.42), and sex ratio 9450, 14169 (p=0.9) in NCC and CHSS. Duration of ICU admission (29+/-37, 26+/-44 p=0.42), duration of mechanical ventilation (17+/-22, 15+/-19 p=0.17), and APACHE III score at the time of CVC insertion (81+/-34, 82+/-37 p=0.61) were not different between both groups. 2) Mean duration of catheterization was 118 in NCC and 119 in CHSS (p=0.98). Number of catheter-days was 2176 days in NCC and 3035 days in CHSS. Catheter-related infection occurred in 9 (4.8%) cases receiving NCC and 4 cases (1.5%) receiving CHSS. Catheterrelated infection incidence per 1000 catheter-days was 4.1 and 1.3, respectively (p=0.04). CHSS was associated with a significant reduction of infection in jugular catheters regarding to insertion sites (p=0.01). 3) Microorganisms causing infection were Staphylococcus aureus (n=3), Candida (n=3), coagulase-negative Staphylococci (n=2), and Klebsiella (n=1) in NCC, and Candida species (n=2), coagulase-negative Staphylococci (n=2), Proteus (n=1) in CHSS. CONCLUSION: CHSS has significantly reduced the episodes of infection compared to NCC in jugular catheterization in medical ICU.