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Comparative Effectiveness Review of Antimicrobial Central Venous Catheters

February 27, 2018

Health Problem: Central line-associated bloodstream infections (CLABSIs) have a high rate of mortality among hospital-acquired infections. These infections pose such a high risk because patients who require central venous catheters (CVCs) are usually acutely ill or highly immunosuppressed.

Technology Description: Antimicrobial CVCs (AMCVCs) are identical to uncoated CVCs, except that they are coated with antimicrobial agents such as minocycline and rifampicin (M-R); chlorhexidine and silver sulfadiazine; or a compound of silver, platinum, and carbon black.

Controversy: The use of AMCVCs has demonstrated a reduction in the risk of CLABSIs across multiple pooled analyses when compared with uncoated catheters; however, cost-effectiveness analyses modeling the savings from CLABSI reductions versus the cost increase for AMCVCs over uncoated CVCs found mixed results. The use of antibiotic-impregnated CVCs has also been considered to pose a potential risk for antimicrobial resistance, although evidence from a recent study did not find a change in antimicrobial resistance patterns after the adoption of M-R-coated CVCs in an intensive care unit during more than a 10-year period.

Key Questions:

  • Do AMCVCs reduce the occurrence of CLABSIs compared with usual (uncoated) CVCs?
  • How do AMCVCs compare with each other regarding reduction in CLABSIs?
  • Are there safety concerns related to AMCVCs?
  • Have definitive patient selection criteria for the use of AMCVCs been established?