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| Identifier |
000349880 |
| Title |
Διερεύνηση της δυνατότητας περιστολής της συχνότητας αιματογενών λοιμώξεων που σχετίζονται με τη χρήση μόνιμων φεβικών καθετήρων σε νεοπλασματικούς ασθενείς : μια προοπτική, τυχαιοποιημένη, διπλά τυφλή μελέτη |
| Alternative Title |
Central venous catheters impregnated with minocycline and rifampin for the prevention of catheter-related bloodstream infections in patients with cancer : a prospective, randomized, double-blind trial |
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Author
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Χατζηνικολάου, Ιωάννης Α
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Thesis advisor
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Σαμώνης, Γεώργιος
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Reviewer
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Γεωργούλιας, Βασίλειος
Μπούρος, Δημοσθένης
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| Abstract |
The introduction of long term catheters in mainstream clinical practice has significantly improved the care of chronically ill patients. Unfortunately their use is associated with complications, the most frequent and serious of which being catheter-related infections. One way of reducing such infections is the use of antibiotic coated catheters. The available experience with such devices is focused exclusively on polyurethane catheters dwelling for a short period of time. In addition concerns are raised that such devices might induce microbial resistance to the antibiotics used, with the available limited literature referring primarily on in vitro conditions or on short term catheterizations.
Purpose: To evaluate the efficacy of long-term non-tunneled silicone central venous catheters (CVC) impregnated with minocycline and rifampin (MR-CVC) in reducing catheter-related bloodstream infections (CRBSI). Additionally to evaluate the possibility that the prolonged clinical use of such catheters is associated with an increased risk for development of staphylococcal resistance to the antibiotics used in coating the catheters.
Participants and Methods: Two independent studies were conducted. In order to evaluate the safety and efficacy of MR-CVC in preventing CRBSI, a prospective, randomized, double-blind clinical trial was conducted at M. D. Anderson Cancer Center (MDACC), a tertiary care hospital in Houston, Texas, USA. All patients in the trial had a malignancy and required a new insertion of a long term intravenous catheter (subclavian or peripherally inserted central venous catheter). The participants were randomized to receive either a MR-CVC or an uncoated CVC (control). All patients were followed up closely for 100 days post
catheter insertion or till the study catheter was removed, whichever event took place first. All events pertaining to the study-catheter were recorded in details.
In order to evaluate the impact of the clinical use of MR-CVC on the susceptibility patterns of bacterial isolates causing infections, we conducted a separate independent retrospective study. Based on the fact that in MDACC all BMT recipients during the pre-engraftment period receive MR-CVC as an standard infection control policy for preventing CRBSI whereas MR-CVCs are not part of standard care in the leukemia department, we evaluated the impact of a 4 year period or MR-CVC clinical use on the susceptibility patterns of Staphylococcus spp. isolates causing primary bloodstream infections in BMT patients.
Results: The prospective study took place between September 1999 and May 2002. In total 356 evaluable catheters were used, 182 MR-CVC and 174 non-impregnated ones. The patients’ characteristics were comparable between the two study groups. The mean duration of catheterization with MR-CVC was comparable to that of non-impregnated catheters (66.21 + 30.88 vs 63.01 + 30.80 days). A total of 17 catheter-related bloodstream infections occurred during the course of the prospective study, 3 were associated with the use of MR-CVC and 14 with the non-impregnated catheters, with a rate of catheter-related bloodstream infection of 0.25 and 1.28/1,000 catheter-days, respectively (p = 0.003). Gram positive cocci accounted for the majority of the organisms causing the infections. There were no allergic reactions associated with MR-CVC.
During the study period (July - December 2001) of the retrospective study there were 212 BMT and 460 leukemia in-patients. BMT patients had a higher frequency of GVHD (p<0.001), longer duration (p=0.003) and higher frequency of
catheterization (p<0.001) and were more frequently neutropenic (p<0.001); the duration of neutropenia was longer in leukemia patients (p<0.001). Rifampin was equally used in both services whereas tetracyclines were used more in BMT (p=0.02). The rates of primary staphylococcal bacteremia were 1.2 and 5.4/1,000 patient days for BMT and leukemia patients respectively (p=0.003). Nine staphylococcal isolates from the leukemia and one from the BMT service were resistant to rifampin. No resistance to minocycline was recorded.
Conclusion: Long-term non-tunneled central venous catheters impregnated with minocycline and rifampin are efficacious and safe in reducing catheter-related bloodstream infections in cancer patients and are associated with low risk of development of staphylococcal resistance to minocycline and rifampin.
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| Language |
Greek |
| Subject |
Catheterization adverse affects |
| Issue date |
2008-07-30 |
| Collection
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School/Department--School of Medicine--Department of Medicine--Doctoral theses
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Type of Work--Doctoral theses
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| Permanent Link |
https://elocus.lib.uoc.gr//dlib/8/0/2/metadata-dlib-c92d3b74affec5d63cf0a121cd0c5072_1253261555.tkl
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