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January 26, 2000

Central Venous Catheters and Bloodstream Infection

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorMargaret A.WinkerMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(4):477-479. doi:10.1001/jama.283.4.475

To the Editor: In their meta-analysis, Dr Veenstra and colleagues1 concluded that catheters coated with a combination of chlorhexidine and silver sulfadiazine (CSS) appear to be effective in reducing the incidence of both catheter colonization and catheter-related bloodstream infection in patients at high risk for catheter-related infection. However, the individual trials do not provide strong evidence of efficacy overall. The largest clinical trial, performed by Logghe et al,2 was excluded because of the definition of catheter-related bacteremia. In this study, catheter-related bacteremia was defined as blood from the catheter containing at least 5 times as many colony forming units as peripheral blood. When the central venous catheter cannot be removed, the method appears adequate for the diagnosis of catheter-related bacteremia and has been reported to have 77.8% sensitivity, 100% specificity, and a global accuracy of 91.7%.3 In this study, a total of 680 catheters were inserted in patients with hematologic malignancies who were treated with chemotherapy. No statistically significant difference for either catheter colonization or catheter-related bacteremia infection was observed between impregnated and conventional catheters (median, 19 days indwelling time).2 For a valid estimation of end points, the clinical trial by Logghe et al2 should be included in the meta-analysis.

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