Devices and InfectionWhich antimicrobial impregnated central venous catheter should we use? Modeling the costs and outcomes of antimicrobial catheter use*,**
Section snippets
Model
Like the authors of a prior catheter cost-effectiveness study,9 we used decision models to compare the outcomes of patients catheterized with minocycline/rifampin catheters with those of patients catheterized with chlorhexidine/silver sulfadiazine catheters and the associated costs for each group.17, 18 We built 25 models representing patients catheterized for different durations: 1 to 25 days (Fig 1).We choose externally
Results
Because no cases of CR-BSI occurred among patients randomized to the minocycline/rifampin catheters for the first 7 days of catheterization,13 we were unable to estimate the relative risk of CR-BSI and the cost-effectiveness of the minocycline/rifampin catheters for patients expected to be catheterized less than 8 days.
Among patients expected to be catheterized more than 1 week, the clinical and economic benefits of the minocycline/rifampin catheters increased with the duration of
Discussion
We compared the clinical and economic consequences of the use of central venous catheters coated with minocycline/rifampin versus chlorhexidine/silver sulfadiazine in patients at high risk for CR-BSI by decision analytic techniques. Our analysis demonstrated that the probability of cost-effectiveness and cost-savings depended on the duration patients were expected to be catheterized. Because of limited data, we were unable to evaluate whether the minocycline/rifampin catheters were
Acknowledgements
We thank Rabih Darouiche, MD, for sharing his data; Leonard Mermel, DO, and Thomas M. Hooton, MD, for sharing their clinical expertise; and the Research Foundation for the Prevention of Complications Associated with Health Care for funding the study.
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Cited by (65)
Understanding Biofilms and Novel Approaches to the Diagnosis, Prevention, and Treatment of Medical Device-Associated Infections
2018, Infectious Disease Clinics of North AmericaCitation Excerpt :Minocycline-rifampin catheters, which are commercially available, have been associated with decreases in microbial colonization and CLABSI.59 Impregnated and standard catheters have similar CLABSI risks over first 10 days after placement, a cost-effectiveness analysis suggested minocycline-rifampin catheters to be most attractive if the catheter is anticipated to be in place for 8 days or more.60 Chlorhexidine-silver sulfadiazine catheters also decrease microbial colonization of surfaces.61
Breaking the Chain of Infection in Older Adults: A Review of Risk Factors and Strategies for Preventing Device-Related Infections
2017, Infectious Disease Clinics of North AmericaCitation Excerpt :Chlorhexidine-impregnated PICCs are also available, but studies demonstrate mixed results with these devices.118,131 Clinically, impregnated and standard catheters have similar CLABSI risk during the first 10 days after placement, and a cost-effectiveness analysis suggested that minocycline/rifampin catheters are an attractive strategy only if the catheter is in place for 8 days or more.132 Considering the higher costs associated with these interventions and the limited resources for infection prevention available at LTCFs, the decision to implement these additional infection prevention measures should be considered based on the risk of incident CLABSI and anticipated duration of CVC need.133
Review: Antimicrobial efficacy validation using in vitro and in vivo testing methods
2017, Advanced Drug Delivery ReviewsThe influence of using antibiotic-coated peripherally inserted central catheters on decreasing the risk of central line-associated bloodstream infections
2016, American Journal of Infection ControlCitation Excerpt :Because these M/R-coated catheters were shown to have an antimicrobial durability of 30-50 days they were found to have an influence in decreasing the risk of CLABSI in patients with long-term duration of therapy (ie, around 60 days of dwell time).9,13 Furthermore, the use of these M/R-coated catheters has been associated with substantial cost savings.14,15 In addition, the heavy use of M/R-coated catheters for more than 500,000 catheter-days over a 7-year period in cancer patients at our institution was not associated with emergence of resistance.16
Estimating duration of central venous catheter at time of insertion: Clinician judgment and clinical predictors
2015, Journal of Critical CareInfections Caused by Percutaneous Intravascular Devices
2014, Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases
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Dr Saint was supported by a Career Development Award from the VA Health Services Research and Development Service during the time much of this work was completed.
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Reprint requests: David L. Veenstra, PharmD, PhD, Pharmaceutical Outcomes Research and Policy Program, Department of Pharmacy, University of Washington, Box 357630, Seattle, WA 98195.