Benefits of minocycline and rifampin-impregnated central venous catheters: A prospective, randomized, double-blind, controlled, multicenter trial

Abstract

Objective: To determine the efficacy of minocycline and rifampin-impregnated catheters compared to non-impregnated catheters in critically ill patients. Design: Prospective, randomized, double-blind, controlled, multicenter trial. Setting: Intensive care units of seven acute-care teaching hospitals in Spain. Patients: Intensive care unit patients requiring triple-lumen central venous catheter for more than 3 days. Interventions: At catheter insertion, 228 patients were randomized to minocycline and rifampin-impregnated catheters and 237 to non-impregnated catheters. Skin, catheter tip, subcutaneous segment, hub cultures, peripheral blood and infusate cultures were performed at catheter withdrawal. The rate of colonization, catheter-related bloodstream infection (CRBSI) and catheter-related clinical infectious complications ( purulence at the insertion site or CRBSI) were assessed. Measurements and main results: In the intention-to- treat analysis ( primary analysis), the episodes per 1000 catheter days of clinical infectious complications decreased from 8.6 to 5.7 (RR = 0.67, 95% CI 0.31 - 1.44), CRBSI from 5.9 to 3.1 ( RR = 0.53, 95% CI 0.2 - 1.44) and tip colonization from 24 to 10.4 ( RR = 0.43, 95% CI 0.26 - 0.73). Antimicrobial-impregnated catheters were associated with a significant decrease of coagulase-negative staphylococci colonization ( RR = 0.24, 95% CI 0.13 - 0.45) and a significant increase of Candida spp. colonization ( RR = 5.84, 95% CI 1.31 - 26.1). Conclusions: The use of antimicrobial-impregnated catheters was associated with a significantly lower rate of coagulase-negative staphylococci colonization and a significant increase in Candida spp. colonization, although a decrease in CRBSI, increase in 30-day survival or reduced length of stay was not observed.