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Central venous catheters coated with minocycline and rifampin for the prevention of catheter-related colonization and bloodstream infections. A randomized, double-blind trial. The Texas Medical Center Catheter Study Group.

BACKGROUND
Central venous catheters are a principal source of nosocomial bloodstream infections, which are difficult to control.


OBJECTIVE
To determine the efficacy of catheters coated with minocycline and rifampin in preventing catheter-related colonization and bloodstream infections.


DESIGN
Multicenter, randomized clinical trial.


SETTING
Five university-based medical centers.


PATIENTS
281 hospitalized patients who required 298 triple-lumen, polyurethane venous catheters.


INTERVENTION
147 catheters were pretreated with tridodecylmethyl-ammonium chloride and coated with minocycline and rifampin. Untreated, uncoated catheters (n = 151) were used as controls.


MEASUREMENTS
Quantitative catheter cultures, blood cultures, and molecular typing of organisms to determine catheter-related colonization and bloodstream infections.


RESULTS
The group with coated catheters and the group with uncoated catheters were similar with respect to age, sex, underlying diseases, degree of immunosuppression, therapeutic interventions, and risk factors for catheter infections. Colonization occurred in 36 (26%) uncoated catheters and 11 (8%) coated catheters (P < 0.001). Catheter-related bloodstream infection developed in 7 patients (5%) with uncoated catheters and no patients with coated catheters (P < 0.01). Multivariate logistic regression analysis showed that coating catheters with minocycline and rifampin was an independent protective factor against catheter-related colonization (P < 0.05). No adverse effects related to the coated catheters or antimicrobial resistance were seen. An estimate showed that the use of coated catheters could save costs.


CONCLUSIONS
Central venous catheters coated with minocycline and rifampin can significantly reduce the risk for catheter-related colonization and bloodstream infections. The use of these catheters may save costs.