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Trial of Antibiotic Central Venous Catheters in Children
Study Questions:
What is the effectiveness of catheters impregnated with antibiotics or heparin as compared with standard central venous catheters (CVCs) to prevent bloodstream infections in children needing intensive care?
Methods:
CATCH was a randomized controlled trial of children admitted to 14 English pediatric intensive care units. Children <16 years of age were eligible if they were expected to require a CVC for ≥3 days. Children were randomly assigned (1:1:1) to receive a CVC impregnated with antibiotics, a CVC impregnated with heparin, or a standard CVC. The primary outcome measure was time to first bloodstream infection between 48 hours after randomization and 48 hours after CVC removal with impregnated (antibiotic or heparin) versus standard CVC.
Results:
A total of 1,853 children were recruited, and 502 children were randomly assigned to receive standard CVCs, 486 to receive antibiotic-impregnated CVCs, and 497 to receive heparin-impregnated CVCs. Bloodstream infection occurred in 18 (4%) of those in the standard catheter group, 7 (1%) in the antibiotic-impregnated group, and 17 (3%) assigned to heparin-impregnated catheters. There was no difference in the primary outcome measure of time to first blood stream infection for combined heparin- and antibiotic-impregnated CVCs as compared with standard CVCs (hazard ratio [HR], 0.71; 95% confidence interval [CI], 0.37-1.34). Secondary analyses showed antibiotic-impregnated CVCs to be superior to standard CVCs (HR, 0.43; 95% CI, 0.20-0.86) and heparin-impregnated CVCs (HR, 0.42; 95% CI, 0.19-0.93). There was no advantage of heparin-impregnated CVCs over standard CVCs. The number needed to treat for antibiotic impregnated catheters versus standard catheters was 47 (95% CI, 25-100).
Conclusions:
Antibiotic-impregnated CVCs significantly reduced the risk of bloodstream infections as compared with standard and heparin-impregnated catheters.
Perspective:
Improvement in catheter-placement techniques as well as maintenance has resulted in significant improvement in the rate of catheter-associated bloodstream infections. We are moving towards a point of nearly zero-tolerance for this nosocomial complication. Many intensive care units have moved towards the use of antibiotic-impregnated catheters for pediatric patients. This study provides data to support this, demonstrating benefit of antibiotic- but not heparin-impregnated catheters over standard catheters in reducing bloodstream infections. Slightly under one third of catheters were placed in the operating room. A relatively large number (approximately one half of all patients enrolled) had cardiovascular problems as their primary diagnosis at admission.
Keywords: Anti-Bacterial Agents, Bacteremia, Catheter-Related Infections, Central Venous Catheters, Cross Infection, Heart Defects, Congenital, Heparin, Intensive Care Units, Pediatric, Operating Rooms, Outcome Assessment, Health Care, Pediatrics, Secondary Prevention
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