Chemaly, R.F., Sharma, P.S., Youssef, S., Gerber, D., Hwu, P., Hanmod, S.S., . . . Raad, I.I. (2010). The efficacy of catheters coated with minocycline and rifampin in the prevention of catheter-related bacteremia in cancer patients receiving high-dose interleukin-2. International Journal of Infectious Diseases, 14, e548–e552.

The purpose of this study was to evaluate effects of antibiotic-coated central venous catheters as compared to non-coated central venous catheters on the development of catheter-associated blood stream infection.

Data was retrospectively analyzed from December 1, 2003 through August 31, 2006 at an inpatient center for patients treated with interleukin-2. Prior to December 2004, non-coated tunneled catheters (NC-C)  were used in these patients; antibiotic-coated catheters were used after December 2004. The coated catheters contained minocycline and rifampin (M/R-C) in their coating. All patients received antibiotic prophylaxis. Cases of catheter-related infection were retrospectively analyzed and compared between the two groups. Catheter insertion and line care remained the same for both groups independent of the type of catheter inserted.

• The study reviewed 78 and 107 episodes of catheter use.
• The age range of studied participants was 26–66 years.
• Sixty-one percent of reviewed participants were diagnosed with melanoma and renal cell carcinoma.
• Non-coated catheters were used in 77 episodes, and M/R-C-coated catheters were used in 30 episodes. All patients received IV nafcillin (67%), clindamycin (15%), or levofloxacin (13%) during high-dose interleukin-2 for 48 hours afterwards.

A single-site inpatient setting.

Active treatment

Retrospective descriptive

• Catheter colonization was defined as the isolation of 15 colony-forming units (CFU) of any microorganism from a catheter tip or subcutaneous segment; or any organism from a blood culture drawn through the catheter during routine surveillance in the absence of fever.
• Local catheter-related infection was defined as exit site infection as demonstrated by purulent drainage from the catheter site.
• Probable catheter-related bacteremia (CRB) was defined as the presence of an indwelling central venous catheter (CVC) with at least one positive blood culture from the peripheral vein, with clinical manifestations of infection.
• Definite CRB was defined as the presence of an indwelling CVC with at least one positive blood culture from the peripheral vein, manifestations of infection, and no apparent source for the blood stream infection except the catheter. Response to treatment was defined as the resolution of all clinical and microbiological manifestations of catheter-related infection, and failure to treatment was defined as persistence of the clinical signs and symptoms of the infection and positive microbiological data.
   

A total of nine episodes of CRB were identified (six were probable and three definite), all in patients with NC-C (M/R-C 0% versus NC-C 12%; p = 0.06). In three of the nine episodes of bacteremia, the blood cultures grew more than one pathogen and in all nine cases, the prophylactic antibiotic had no activity against the pathogen. The causative pathogens for CRB included methicillin-resistant, coagulase-negative infections. There was one episode of probable catheter-related candidemia (Candidaparapsilosis) in a patient with a coated catheter, while two episodes of catheter colonization secondary to coagulase-negative Staphylococci occurred in two patients who had no signs or symptoms of infection.

Based on the data presented, there is potential benefit to an antibiotic-coated catheter compared with a non-coated catheter.

• Small sample (less than 100 participants)
• Only 30 cases with coated catheters
• Retrospective design

No recommendations can be made on the basis of this study alone. Antibiotic-coated, short-term CVCs may be helpful in preventing catheter-associated bloodstream infections.