Vokurka, S., Kabatova-Maxova, K., Skardova, J., & Bystricka, E. (2009). Antimicrobial chlorhexidine/silver sulfadiazine-coated central venous catheters versus those uncoated in patients undergoing allogeneic stem cell transplantation. Supportive Care in Cancer, 17, 145–151.

To determine if using antimicrobial-coated central venous catheters (CVCs) is of benefit for patients undergoing stem cell transplantation

Patients were given multilumen polyurethane nontunneled antimicrobial chlorhexidine/silver sulfadiazine-coated CVCs. Transparent occlusive dressings were changed weekly or more frequently as needed. Blood cultures were taken from CVC lumens and peripheral blood on first occurrence of fever or at the discretion of medical staff.  Skin swabs were taken from around the CVC insertion site with dressing changes before local disinfection. Povidone-iodine was used for skin disinfection with dressing changes and before CVC insertion. CVC insertion was stated to be under strict aseptic technique. Patient outcomes were compared to those of historical controls in whom noncoated CVCs were used.

• N = 107
• MEDIAN AGE = 52 years
• AGE RANGE = 20–68 years
• MALES: 57%, FEMALES: 43%
• KEY DISEASE CHARACTERISTICS: All had hematologic malignancies; 47.7% had acute myeloid leukemia.
   

• SITE: Single site  
• SETTING TYPE: Inpatient  
• LOCATION: Czechoslovakia

• PHASE OF CARE: Active antitumor treatment

• Prospective
  • Comparison to historic controls

• Insertion site infection: positive skin swabs
• Catheter-related blood stream infection: no apparent source other than CVC and blood culture positive with the same microorganism
   

Patients experienced fewer days with fever per 1,000 catheter days with the antimicrobial CVC (p < .001). No significant differences were observed between groups in insertion site inflammation or infection. Significantly fewer patients in the coated CVC group had positive blood cultures (45% versus 36%, p < .05) and peripheral positive blood cultures (p = .005).

 This study provides minimal support that antimicrobial-coated CVCs may be of benefit for patients undergoing stem cell transplantation.

• Risk of bias (no control group) 
• Risk of bias (no blinding)  
• Risk of bias (no random assignment)
• Unintended interventions or applicable interventions not described that would influence results
• Selective outcomes reporting
• Measurement/methods not well described  
• Measurement validity/reliability questionable
• Questionable protocol fidelity
• Other limitations/explanation: Whether the exact same approaches for CVC insertion were used in the prospective and historic groups is not clear. Although CVC-related infection clearly was defined, results were not reported in this way, so whether the blood and CVC culture differences were CVC-related infection, as defined, is not clear. No information is provided on whether other methods, such as prophylactic antimicrobial therapy or colony-stimulating factors, were used or differed between groups.

Results do not provide strong supportive evidence for use of chlorhexidine/silver sulfadiazine-coated CVCs because of study limitations.