Long-term catheterization: current approaches in the diagnosis and treatment of port-related infections

Figures & data

Figure 1 Biofilm development.

Notes: I Planktonic bacteria; II Attachment of bacterial cells; III Bacterial cells form a biofilm using their pili and exopolysaccharide; IV Mature biofilm; V Release of micro-organisms to the bloodstream.

Table 1 Summary of some RCT and controlled studies’ published articles on catheter infection and prevention of CRBSI

Design	N	Intervention	Main conclusion	Reference
Retrospective	54	Oral prophylaxis with doxycycline in HCT patients	No CVC infection in the doxycycline group	^Citation62
Retrospective	459	Single dose of antibiotic during placement of TIVPAs	Decrease of CRI	^Citation63
Observational	179	Perioperative prophylactic cefuroxime administration	No CRBSI reported	^Citation64
Crossover, randomized	26	Oral prophylaxis with novobiocin and rifampin	Effectiveness of antibiotic prophylaxis	^Citation65
Randomized	40	3 days of vancomycin during insertion of CVC	Bacteremic episodes reduced in the vancomycin group	^Citation66
Randomized, controlled	148	Amoxicillin prophylaxis to prevent CRI	Failure to demonstrate benefit of amoxicillin prophylaxis	^Citation67
Randomized	88	Teicoplanin before insertion of Hickman catheter	Lower incidence of CRS in teicoplanin arm	^Citation68
Randomized, controlled	98	Vancomycin during placement of long-term CVC	Failure to reduce CRS	^Citation69
Randomized	47	Single dose of vancomycin at time of insertion of CVC	Failure to reduce CRS	^Citation70
Ethanol lock technique
Retrospective	31	70% ethanol lock solution followed by NaCl 0.9% flushing	Reduced CRBSI-related admissions	^Citation71
Randomized, double-blind	376	70% ethanol vs placebo for 15 minutes followed by NaCl 0.9% flushing	No significant difference between groups	^Citation72
Prospective, open-label	12	Overnight 70% ethanol lock solution	No significant difference observed	^Citation73
Antiseptic-impregnated and antibiotic-impregnated catheters
Randomized	133	Chlorhexidine and silver sulfadiazine catheters vs nonimpregnated	Failure to reduce incidence of colonization or CRBSI	^Citation74
Randomized	204	Chlorhexidine and silver sulfadiazine catheter vs no antiseptic catheter	No significant difference between groups	^Citation75
Randomized, double-blind	370	Minocycline and rifampin catheters vs no antimicrobial catheters	Antimicrobial catheters decreased CRI	^Citation76
Randomized	228	Chlorhexidine and silver sulfadiazine catheters vs no antiseptic catheters	Antiseptic-bonded catheters have lower colonization rate	^Citation77
Randomized	817	Chlorhexidine and sulfadiazine vs minocycline and rifampin catheters	Antibiotic catheters had lower colonization and CRBSI	^Citation78
Randomized, controlled	119	Chlorhexidine and sulfadiazine catheters vs nonimpregnated	Reduction of colonization in the antibiotic arm	^Citation79
Randomized, double-blind	538	Chlorhexidine and silver sulfadiazine catheters vs nonimpregnated	No significant difference between groups	^Citation80
Randomized, controlled	158	Chlorhexidine and silver sulfadiazine catheters vs nonimpregnated	Reduced incidence of CRI	^Citation81
Randomized, double-blind	281	Coated minocycline and rifampin CVC	Antibiotic-coated CVC reduced colonization and BSI	^Citation82
Randomized	233	Chlorhexidine and sulfadiazine catheters vs nonimpregnated	Reduction of colonization in the antibiotic group	^Citation83
Randomized	20	Teicoplanin-coated CVC vs noncoated antibiotic CVC	No significant difference between groups	^Citation84

Abbreviations: BSI, bloodstream infection; CRBSI, catheter-related bloodstream infection; CRI, catheter-related infection; CRS, catheter-related sepsis; CVC, central venous catheter; HCT, hematopoietic cell transplantation; RCT, randomized controlled trial; TIVPA, totally implanted venous port access; vs, versus.

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