Srinivasan A, et al. MMWR 60: 2011; CDC BHSN 2010 Data Summary; Umscheid CA, et al. Infect Control Hosp Epidemiol. 2011; 32:101-114. Scott RD. Division of Healthcare Quality Promotion, CDC, 2009.

CHG/SS

M/R Silver/Platinum/ Carbon (Silver Iontophoretic; Vantex)

Hydrocath Assure (BD) Benzalkonium AMC Thromboshield (Edwards) Benzalkonium Heparin Multistar

Miconazole/Rifampin (Vygon)

M/R

C C/S

S/C/P

Staphylococcus epidermidis

Spangler & Moss, Arrow International

Pseudomonas aeruginosa

Spangler & Moss, Arrow International

S/C/P

C/S

M/R

C

Candida albicans

C/S C

S/C/P M/R

CH/SS: Poor activity vs Acinetobacter, Stenotrophomonas, Enterobacter

Medline search of articles with “meta-analysis” in title, 2007-2011

Meta Analysis

  Quality of Reporting of Meta-Analysis (QUORUM) guidelines

Silver Alloy (0.58)

Silver Iontoph (1.98)

Silver Impreg (0.93)

BenzChl (1.0)

BSI

Colonization

Silver Alloy (1.21)

Rif/Micon (0.14) Casey AL, et al. Lancet ID, 2008

Ramritu AJIC 2008

Scatter plot of 29 studies (BSI vs. colonization) Spearman Correlation coefficient: r = 0.63, r2 = 0.4; P = 0.003

Casey AL, et al. Lancet ID, 2008

0.29

0.47

0.68

2.3%

5.9%

4.2%

Do antimicrobial-coated catheters prevent BSI?

1

2

S. aureus 1st & 2nd generation CH/SS CVCs

S. epidermidis 2nd generation CH/SS CVC

Bassetti, et al AAC 2001 Fey et al, ICAAC, 2000

(58 explanted CVCs)

Duration of activity of M/R appears to be greater than CH/SS

Chest, 2004

Crit Care Med, 2011

Veenstra DL, et al. JAMA 1999

Shorr AF, et al. Chest 2003

Marciante KD, et al. AJIC 2003

Veenstra DL, et al. JAMA 1999 “…the use of chlorhexidine-silver sulfadiazine impregnated catheters in patients at high risk for infection reduces the incidence of CR-BSI and death and provides significant saving in costs.”

Shorr AF, et al. Chest 2003 “Utilization of antiseptic and antibiotic-impregnated CVCs represent an attractive alternative for prevention of CRBSIs and may lead to significant savings. … the RM CVC performs better financially.”

Marciante KD, et al. AJIC 2003 “CVCs coated with M/R are cost effective for patients catheterized for at least one week and lead to overall cost savings when patients are catheterized for 2 weeks or longer.”

Conclusions from Cost Effectiveness Studies

Health Technology Assessment, 2008

Crit Care, 2009

GND X M/R * CH/SS SPC

(MRSA)

Durability vs MRSA

Uncoated M/R CH-M/R CH/SS

Spectrum of Activity

Uncoated M/R CH-M/R CH/SS

MRSA P.aer C. albicans C. glabrata

Kaplan Meier analysis of colonization

Walz, et al. Crit Care Med, 2010