Schierholz, J.M., Nagelschmidt, K., Nagelschmidt, M., Lefering, R., Yucel, N., & Beuth, J. (2010). Antimicrobial central venous catheters in oncology: Efficacy of a rifampicin-miconazole-releasing catheter. Anticancer Research, 30, 1353–1358.

The purpose of the study was to determine if central venous catheters (CVCs) impregnated with rifampicin and miconazole would decrease growth of bacteria and lead to a decline in catheter-related bloodstream infections as well as the complications associated with them.

Hospitalized adults (aged 18–80 years) who required a CVC for at least two days and were undergoing their first venous catheterization were included in this study. A triple lumen polyurethane CVC supersaturated with rifampicin andmiconazole was compared with the standard version. A segment of the catheter was cultured to evaluate catheter colonization. Catheter colonization was defined as growth of 15 or more colony-forming units detected on a catheter segment by the semi-quantitative roll-plate technique. Catheter-related local infection was defined as a colonized catheter accompanied by at least one of the following criteria: redness, induration/swelling, purulent secretion, and/or pain.

• The total sample included 223 participants.
• The mean age was 61 years (range = 21–80)
• Male participants made up 69% of the sample; female participants made up 31%.
• Participants were hospitalized surgical patients requiring a CVC (84 patients [38%] with oncological diagnoses.
• Overall catheter indwelling time was 6.7 days (SD = 3.2) in the control group and 7.5 days (SD = 4.7) in the intervention group. However, long-term indwelling  (more than seven days) was significantly higher in the intervention group (10.8 days [SD = 4.9], median = 9 days, n = 46) than in the control group (9.2 days [SD = 2.9], median = 8 years, n = 48) (p = 0.029).

Single inpatient setting in Germany.

Active treatment

Prospective-controlled, non-blinded, randomized clinical trial.

• Microbiologic evaluation
• Swab samples taken from the catheter connectors (hub) and the skin at the site of catheter insertion
• Cultures of  the IV part of the catheter.
• After removal of the catheter, ex vivo activity of the antimicrobial catheters was measured as the mean diameter of inhibition towards Staphylococcus epidermidis RP62A.

Compared to the standard device, modified CVCs showed significantly lower catheter colonization as well as catheter-related infection during short-term (less than seven days, p = 0.001), as well as during long-term (seven days or more, p = 0.001). In the control group,38 (36.3%) of the 105 standard CVCs were colonized. In the intervention group, 6 of 118 loaded CVCs were colonized (5.1%). The colonization rate in the oncology subgroup did not differ greatly from the rate of the patients without cancer (39% versus 34.4%, p = 0.629); however, the catheter-related infection rate was significantly higher in patients with cancer. The catheter-related infection rate of oncologic patients was reduced from 26.8% to 2.3% using the loaded CVC, indicating its pronounced efficacy in preventing catheter-related infection in patients with cancer (p < 0.001). The main covariate for catheter colonization was colonization of the skin at the catheter site (p = 0.001), underscoring the importance of hygienic site care.

Use of an impregnated antimicrobial catheter in patients with cancer has the potential to decrease the risk of catheter-related bloodstream infections and the associated complications.

• Only 38% of the patients in this study had an oncologic diagnosis (n = 84)
• All of the patients were surgical patients.

CVCs impregnated with rifampicin and miconazole may decrease the risk of catheter-related infections and appear to exert their antimicrobial effect for more than four weeks. Additional study is needed to evaluate these catheters in a general oncology population with a larger sample. Skin colonization was associated with increased risk of catheter colonization, emphasizing the importance of meticulous site care.