Double-lumen central venous catheters impregnated with chlorhexidine and silver sulfadiazine to prevent catheter colonisation in the intensive care unit setting: a prospective randomised study.

Antimicrobial- and antiseptic-impregnated catheters are strategies recommended to prevent central venous catheter (CVC) colonisation. Few data regarding chlorhexidine/silver sulfadiazine-impregnated catheters in intensive care unit (ICU) patients have been reported. We performed a prospective, randomised study comparing the colonisation rates of chlorhexidine/silver sulfadiazine-impregnated CVCs (group 1) against standard CVCs (group 2). In order to assess catheter colonisation rates, a 4cm segment from the tips of aseptically removed catheters was cultured by the roll-plate method. In all, 109 patients were enrolled with successful catheter insertion, 51 of them in group 1 and 58 in group 2. There were no statistically significant differences between the two groups with regards to age, Sequential Organ Failure Assessment (SOFA) score, ICU admission diagnosis, infection risk, catheter insertion sites or catheter length of stay. The colonisation rates were 29.4% (15 catheters) for group 1 and 34.5% (20 catheters) for group 2 (P=0.50). Double-lumen CVCs impregnated with chlorhexidine and silver sulfadiazine were not effective in reducing the incidence of catheter colonisation in ICU patients.

Central venous sinus thrombosis following mastoiditis: report of 4 cases and literature review.

The frequency of mastoiditis and its complications have declined since the advent of antibiotics. Among all complications, transverse sinus thrombosis is the least frequent, although it may have the highest mortality rate. Before the introduction of surgery and antibiotic treatment, mortality was close to 100%. Previous administration of antibiotics may lead to changes in the clinical presentation of venous sinus thrombosis that make diagnosis more difficult, in spite of greatly improved imaging methods. This article reports 4 confirmed cases of venous sinus thrombosis complicating mastoiditis that were diagnosed and treated at Nossa Senhora das Graças Hospital, Curitiba--PR from June, 1999, to February, 2000. All 4 cases were documented by magnetic resonance imaging. Each patient recovered after treatment with antibiotics and anticoagulation. No surgical intervention was necessary. Diagnosis of the complication requires a high level of clinical suspicion and then evaluation by mastoid CT and cranial MRI.