D L Veenstra1, S Saint, S D Sullivan. 1. Pharmaceutical Outcomes Research and Policy Program and Department of Pharmacy, University of Washington, Seattle 98195-7630, USA. veenstra@u.washington.edu
Abstract
CONTEXT: A recent randomized controlled trial and meta-analysis indicated that central venous catheters impregnated with an antiseptic combination of chlorhexidine and silver sulfadiazine are efficacious in reducing the incidence of catheter-related bloodstream infection (CR-BSI); however, the ultimate clinical and economic consequences of their use have not been formally evaluated. OBJECTIVE: To estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs standard catheters. DESIGN: Decision analytic model using data from randomized controlled trials, meta-analyses, and case-control studies, as well as safety data from the US Food and Drug Administration. SETTING AND PATIENTS: A hypothetical cohort of hospitalized patients at high risk for catheter-related infections (eg, patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter. INTERVENTION: Short-term use (2-10 days) of chlorhexidine-silver sulfadiazine-impregnated multilumen central venous catheters and nonimpregnated catheters. MAIN OUTCOME MEASURES: Expected incidence of CR-BSI and death attributable to antiseptic-impregnated and standard catheter use; direct medical costs for both types of catheters. RESULTS: In the base-case analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs 3.0% for antiseptic-impregnated catheters), a decrease in the incidence of death of 0.33% (0.78% for standard vs 0.45% for antiseptic-impregnated), and a decrease in costs of $196 per catheter used ($532 for standard vs $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis. CONCLUSION: Our analyses suggest that use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of CR-BSI and death and provides significant saving in costs. Use of these catheters should be considered as part of a comprehensive nosocomial infection control program.
CONTEXT: A recent randomized controlled trial and meta-analysis indicated that central venous catheters impregnated with an antiseptic combination of chlorhexidine and silver sulfadiazine are efficacious in reducing the incidence of catheter-related bloodstream infection (CR-BSI); however, the ultimate clinical and economic consequences of their use have not been formally evaluated. OBJECTIVE: To estimate the incremental clinical and economic outcomes associated with the use of antiseptic-impregnated vs standard catheters. DESIGN: Decision analytic model using data from randomized controlled trials, meta-analyses, and case-control studies, as well as safety data from the US Food and Drug Administration. SETTING AND PATIENTS: A hypothetical cohort of hospitalized patients at high risk for catheter-related infections (eg, patients in intensive care units, immunosuppressed patients, and patients receiving total parenteral nutrition) requiring use of a central venous catheter. INTERVENTION: Short-term use (2-10 days) of chlorhexidine-silver sulfadiazine-impregnated multilumen central venous catheters and nonimpregnated catheters. MAIN OUTCOME MEASURES: Expected incidence of CR-BSI and death attributable to antiseptic-impregnated and standard catheter use; direct medical costs for both types of catheters. RESULTS: In the base-case analysis, use of antiseptic-impregnated catheters resulted in a decrease in the incidence of CR-BSI of 2.2% (5.2% for standard vs 3.0% for antiseptic-impregnated catheters), a decrease in the incidence of death of 0.33% (0.78% for standard vs 0.45% for antiseptic-impregnated), and a decrease in costs of $196 per catheter used ($532 for standard vs $336 for antiseptic-impregnated). The decrease in CR-BSI ranged from 1.2% to 3.4%, the decrease in death ranged from 0.09% to 0.78%, and the costs saved ranged from $68 to $391 in a multivariate sensitivity analysis. CONCLUSION: Our analyses suggest that use of chlorhexidine-silver sulfadiazine-impregnated central venous catheters in patients at high risk for catheter-related infections reduces the incidence of CR-BSI and death and provides significant saving in costs. Use of these catheters should be considered as part of a comprehensive nosocomial infection control program.
Authors: Christine Geffers; Irina Zuschneid; Tim Eckmanns; Henning Rüden; Petra Gastmeier Journal: Intensive Care Med Date: 2003-02-08 Impact factor: 17.440
Authors: Naomi P O'Grady; Mary Alexander; Lillian A Burns; E Patchen Dellinger; Jeffrey Garland; Stephen O Heard; Pamela A Lipsett; Henry Masur; Leonard A Mermel; Michele L Pearson; Issam I Raad; Adrienne G Randolph; Mark E Rupp; Sanjay Saint Journal: Clin Infect Dis Date: 2011-04-01 Impact factor: 9.079
Authors: Andrew W Dick; Eli N Perencevich; Monika Pogorzelska-Maziarz; Jack Zwanziger; Elaine L Larson; Patricia W Stone Journal: Am J Infect Control Date: 2015-01 Impact factor: 2.918
Authors: Amani D Politano; Kristin T Campbell; Laura H Rosenberger; Robert G Sawyer Journal: Surg Infect (Larchmt) Date: 2013-02-28 Impact factor: 2.150
Authors: K W Jauch; W Schregel; Z Stanga; S C Bischoff; P Brass; W Hartl; S Muehlebach; E Pscheidl; P Thul; O Volk Journal: Ger Med Sci Date: 2009-11-18