Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial
Exit-site and tunnel infections of tunnelled central intravascular catheters are a frequent source of morbidity among neutropenic patients and may necessitate catheter removal. They require antimicrobial therapy that increases healthcare costs and is associated with adverse drug reactions. A prospec...
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| Veröffentlicht in: | The Journal of hospital infection 2005-09, Vol.61 (1), p.53-61 |
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| creator | Chambers, S.T. Sanders, J. Patton, W.N. Ganly, P. Birch, M. Crump, J.A. Spearing, R.L. |
| description | Exit-site and tunnel infections of tunnelled central intravascular catheters are a frequent source of morbidity among neutropenic patients and may necessitate catheter removal. They require antimicrobial therapy that increases healthcare costs and is associated with adverse drug reactions. A prospective randomized clinical trial was conducted among adult patients undergoing chemotherapy in a haematology unit. Tunnelled intravascular catheters were randomized to receive the control of a standard dressing regimen as recommended by the British Committee for Standards in Haematology, or to receive the intervention of a sustained-release chlorhexidine dressing. Follow-up data were available in 112 of 114 tunnelled intravascular catheters which were randomized. Exit-site or combined exit-site/tunnel infections occurred in 23 (43%) of 54 catheters in the control group, and five (9%) of 58 catheters in the intervention group [odds ratio (OR) for intervention group compared with control group =0.13, 95% confidence intervals (CI) 0.04–0.37,
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| doi_str_mv | 10.1016/j.jhin.2005.01.023 |
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P<0.001]. More tunnelled intravascular catheters were prematurely removed from the control group than the intervention group for documented infections [20/54 (37%) vs 6/58 (10%), OR=0.20, 95%CI 0.53–0.07]. However, there was no difference in the numbers of tunnelled intravascular catheters removed for all proven and suspected intravascular catheter-related infections [21/54 (39%) vs 19/58 (33%)], or in the time to removal of catheters for any reason other than death or end of treatment for underlying disease. Thus chlorhexidine dressings reduced the incidence of exit-site/tunnel infections of indwelling tunnelled intravascular catheters without prolonging catheter survival in neutropenic patients, and could be considered as part of the routine management of indwelling tunnelled intravascular catheters among neutropenic patients.</description><identifier>ISSN: 0195-6701</identifier><identifier>EISSN: 1532-2939</identifier><identifier>DOI: 10.1016/j.jhin.2005.01.023</identifier><identifier>PMID: 16002181</identifier><language>eng</language><publisher>Kent: Elsevier Ltd</publisher><subject>Administration, Topical ; Adult ; Anti-Infective Agents, Local - administration & dosage ; Antibiotics. Antiinfectious agents. Antiparasitic agents ; Antineoplastic Agents - adverse effects ; Antiseptics ; Bandages ; Biological and medical sciences ; Bone Marrow Transplantation - adverse effects ; Catheters, Indwelling - adverse effects ; Chemotherapy ; Chlorhexidine ; Chlorhexidine - administration & dosage ; Delayed-Action Preparations ; Exit-site infection ; Hematologic and hematopoietic diseases ; Humans ; Medical sciences ; Neutropenia ; Neutropenia - etiology ; Other diseases. Hematologic involvement in other diseases ; Pharmacology. Drug treatments ; Prospective Studies ; Surgical Wound Infection - etiology ; Surgical Wound Infection - prevention & control ; Treatment Outcome ; Tunnelled intravascular catheter</subject><ispartof>The Journal of hospital infection, 2005-09, Vol.61 (1), p.53-61</ispartof><rights>2005 The Hospital Infection Society</rights><rights>2005 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-82098b9e994237823d8ebe2f13276a5654d00725749f8f93d21482b08e5d147a3</citedby><cites>FETCH-LOGICAL-c464t-82098b9e994237823d8ebe2f13276a5654d00725749f8f93d21482b08e5d147a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0195670105001039$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=17008245$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/16002181$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Chambers, S.T.</creatorcontrib><creatorcontrib>Sanders, J.</creatorcontrib><creatorcontrib>Patton, W.N.</creatorcontrib><creatorcontrib>Ganly, P.</creatorcontrib><creatorcontrib>Birch, M.</creatorcontrib><creatorcontrib>Crump, J.A.</creatorcontrib><creatorcontrib>Spearing, R.L.</creatorcontrib><title>Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial</title><title>The Journal of hospital infection</title><addtitle>J Hosp Infect</addtitle><description>Exit-site and tunnel infections of tunnelled central intravascular catheters are a frequent source of morbidity among neutropenic patients and may necessitate catheter removal. They require antimicrobial therapy that increases healthcare costs and is associated with adverse drug reactions. A prospective randomized clinical trial was conducted among adult patients undergoing chemotherapy in a haematology unit. Tunnelled intravascular catheters were randomized to receive the control of a standard dressing regimen as recommended by the British Committee for Standards in Haematology, or to receive the intervention of a sustained-release chlorhexidine dressing. Follow-up data were available in 112 of 114 tunnelled intravascular catheters which were randomized. Exit-site or combined exit-site/tunnel infections occurred in 23 (43%) of 54 catheters in the control group, and five (9%) of 58 catheters in the intervention group [odds ratio (OR) for intervention group compared with control group =0.13, 95% confidence intervals (CI) 0.04–0.37,
P<0.001]. More tunnelled intravascular catheters were prematurely removed from the control group than the intervention group for documented infections [20/54 (37%) vs 6/58 (10%), OR=0.20, 95%CI 0.53–0.07]. However, there was no difference in the numbers of tunnelled intravascular catheters removed for all proven and suspected intravascular catheter-related infections [21/54 (39%) vs 19/58 (33%)], or in the time to removal of catheters for any reason other than death or end of treatment for underlying disease. Thus chlorhexidine dressings reduced the incidence of exit-site/tunnel infections of indwelling tunnelled intravascular catheters without prolonging catheter survival in neutropenic patients, and could be considered as part of the routine management of indwelling tunnelled intravascular catheters among neutropenic patients.</description><subject>Administration, Topical</subject><subject>Adult</subject><subject>Anti-Infective Agents, Local - administration & dosage</subject><subject>Antibiotics. Antiinfectious agents. Antiparasitic agents</subject><subject>Antineoplastic Agents - adverse effects</subject><subject>Antiseptics</subject><subject>Bandages</subject><subject>Biological and medical sciences</subject><subject>Bone Marrow Transplantation - adverse effects</subject><subject>Catheters, Indwelling - adverse effects</subject><subject>Chemotherapy</subject><subject>Chlorhexidine</subject><subject>Chlorhexidine - administration & dosage</subject><subject>Delayed-Action Preparations</subject><subject>Exit-site infection</subject><subject>Hematologic and hematopoietic diseases</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Neutropenia</subject><subject>Neutropenia - etiology</subject><subject>Other diseases. Hematologic involvement in other diseases</subject><subject>Pharmacology. Drug treatments</subject><subject>Prospective Studies</subject><subject>Surgical Wound Infection - etiology</subject><subject>Surgical Wound Infection - prevention & control</subject><subject>Treatment Outcome</subject><subject>Tunnelled intravascular catheter</subject><issn>0195-6701</issn><issn>1532-2939</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc2KFDEUhQtRnHb0BVxINrqrNkn9pcTNMPgHA4LoOqSSW9NpqpIyN9U4PqDP5e3phtnpKuHw3ZuTc4ripeBbwUX7dr_d73zYSs6bLRdbLqtHxUY0lSxlX_WPiw0XfVO2HRcXxTPEPeec9OZpcSFazqVQYlP8-QZutdnHwOLI4JfPJfoMzIcR7mU86nkNAaYJHOk5mYNBu04mMWvyDjIkZGaO4ZYFWHOKCwRv2WKyh5CRDXcMV8zGB3BlggkMArO7KaYdvedIZi4Bog-3-I7RbZ1oakxxZoYtKeJydHIAlkxwcfa_yYaN5CPeO8rJm-l58WQ0E8KL83lZ_Pj44fv15_Lm66cv11c3pa3bOpdK8l4NPfR9LatOycopGECOopJda5q2qR3nnWy6uh_V2FdOilrJgStonKg7U10Wb057ydfPFTDr2aOlaEyAuKJuVV2JVor_glRar0RXEShPoKWfYoJRL8nPJt1pwfWxZr3Xx5qPE43mQlPNNPTqvH0dZnAPI-deCXh9BqgqM40UnfX4wHWcK1k3xL0_cUChHTwkjZZas-B8otS1i_5fPv4C3LbLqg</recordid><startdate>20050901</startdate><enddate>20050901</enddate><creator>Chambers, S.T.</creator><creator>Sanders, J.</creator><creator>Patton, W.N.</creator><creator>Ganly, P.</creator><creator>Birch, M.</creator><creator>Crump, J.A.</creator><creator>Spearing, R.L.</creator><general>Elsevier Ltd</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T7</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20050901</creationdate><title>Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial</title><author>Chambers, S.T. ; Sanders, J. ; Patton, W.N. ; Ganly, P. ; Birch, M. ; Crump, J.A. ; Spearing, R.L.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-82098b9e994237823d8ebe2f13276a5654d00725749f8f93d21482b08e5d147a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>Administration, Topical</topic><topic>Adult</topic><topic>Anti-Infective Agents, Local - administration & dosage</topic><topic>Antibiotics. Antiinfectious agents. Antiparasitic agents</topic><topic>Antineoplastic Agents - adverse effects</topic><topic>Antiseptics</topic><topic>Bandages</topic><topic>Biological and medical sciences</topic><topic>Bone Marrow Transplantation - adverse effects</topic><topic>Catheters, Indwelling - adverse effects</topic><topic>Chemotherapy</topic><topic>Chlorhexidine</topic><topic>Chlorhexidine - administration & dosage</topic><topic>Delayed-Action Preparations</topic><topic>Exit-site infection</topic><topic>Hematologic and hematopoietic diseases</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Neutropenia</topic><topic>Neutropenia - etiology</topic><topic>Other diseases. Hematologic involvement in other diseases</topic><topic>Pharmacology. Drug treatments</topic><topic>Prospective Studies</topic><topic>Surgical Wound Infection - etiology</topic><topic>Surgical Wound Infection - prevention & control</topic><topic>Treatment Outcome</topic><topic>Tunnelled intravascular catheter</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Chambers, S.T.</creatorcontrib><creatorcontrib>Sanders, J.</creatorcontrib><creatorcontrib>Patton, W.N.</creatorcontrib><creatorcontrib>Ganly, P.</creatorcontrib><creatorcontrib>Birch, M.</creatorcontrib><creatorcontrib>Crump, J.A.</creatorcontrib><creatorcontrib>Spearing, R.L.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of hospital infection</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Chambers, S.T.</au><au>Sanders, J.</au><au>Patton, W.N.</au><au>Ganly, P.</au><au>Birch, M.</au><au>Crump, J.A.</au><au>Spearing, R.L.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial</atitle><jtitle>The Journal of hospital infection</jtitle><addtitle>J Hosp Infect</addtitle><date>2005-09-01</date><risdate>2005</risdate><volume>61</volume><issue>1</issue><spage>53</spage><epage>61</epage><pages>53-61</pages><issn>0195-6701</issn><eissn>1532-2939</eissn><abstract>Exit-site and tunnel infections of tunnelled central intravascular catheters are a frequent source of morbidity among neutropenic patients and may necessitate catheter removal. They require antimicrobial therapy that increases healthcare costs and is associated with adverse drug reactions. A prospective randomized clinical trial was conducted among adult patients undergoing chemotherapy in a haematology unit. Tunnelled intravascular catheters were randomized to receive the control of a standard dressing regimen as recommended by the British Committee for Standards in Haematology, or to receive the intervention of a sustained-release chlorhexidine dressing. Follow-up data were available in 112 of 114 tunnelled intravascular catheters which were randomized. Exit-site or combined exit-site/tunnel infections occurred in 23 (43%) of 54 catheters in the control group, and five (9%) of 58 catheters in the intervention group [odds ratio (OR) for intervention group compared with control group =0.13, 95% confidence intervals (CI) 0.04–0.37,
P<0.001]. More tunnelled intravascular catheters were prematurely removed from the control group than the intervention group for documented infections [20/54 (37%) vs 6/58 (10%), OR=0.20, 95%CI 0.53–0.07]. However, there was no difference in the numbers of tunnelled intravascular catheters removed for all proven and suspected intravascular catheter-related infections [21/54 (39%) vs 19/58 (33%)], or in the time to removal of catheters for any reason other than death or end of treatment for underlying disease. Thus chlorhexidine dressings reduced the incidence of exit-site/tunnel infections of indwelling tunnelled intravascular catheters without prolonging catheter survival in neutropenic patients, and could be considered as part of the routine management of indwelling tunnelled intravascular catheters among neutropenic patients.</abstract><cop>Kent</cop><pub>Elsevier Ltd</pub><pmid>16002181</pmid><doi>10.1016/j.jhin.2005.01.023</doi><tpages>9</tpages></addata></record> |
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| subjects | Administration, Topical Adult Anti-Infective Agents, Local - administration & dosage Antibiotics. Antiinfectious agents. Antiparasitic agents Antineoplastic Agents - adverse effects Antiseptics Bandages Biological and medical sciences Bone Marrow Transplantation - adverse effects Catheters, Indwelling - adverse effects Chemotherapy Chlorhexidine Chlorhexidine - administration & dosage Delayed-Action Preparations Exit-site infection Hematologic and hematopoietic diseases Humans Medical sciences Neutropenia Neutropenia - etiology Other diseases. Hematologic involvement in other diseases Pharmacology. Drug treatments Prospective Studies Surgical Wound Infection - etiology Surgical Wound Infection - prevention & control Treatment Outcome Tunnelled intravascular catheter |
| title | Reduction of exit-site infections of tunnelled intravascular catheters among neutropenic patients by sustained-release chlorhexidine dressings: results from a prospective randomized controlled trial |
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