Chlorhexidine and silver sulfadiazine coating on central venous catheters is not sufficient for protection against catheter-related infection

Simulation-based laboratory research with clinical validation

Yoon Ji Choi, Jae Kwan Lim, Jeong Jun Park, Hyub Huh, Dong Ju Kim, Chang Hoon Gong, Seung-Zhoo Yoon

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: The efficacy of chlorhexidine- and silver sulfadiazine-coated central venous catheters (CSS-CVC) against catheter-related infection remains controversial. We hypothesized that the loss of silver nanoparticles may reduce the antibacterial efficacy of CSS-CVCs and that this loss could be due to the frictional force between the surface of the CVC and the bloodstream. The objective of this study was to investigate whether the antimicrobial effect of CSS-CVCs decreases with increasing exposure time in a bloodstream model and quantitatively assay the antimicrobial effect of CSS-CVCs compared with polyurethane and antiseptic-impregnated CVCs. Methods: Each CVC was subjected to 120 hours of saline flow and analyzed at intervals over 24 hours. The analyses included energy-dispersive X-ray spectroscopy, scanning electron microscopy, and optical density after a Staphylococcus aureus incubation test. Results: The weight percentage of silver in the CSS-CVCs significantly decreased to 56.18% (44.10% ± 3.32%) with 48-hour catheterization and to 18.88% (14.82% ± 1.33%) with 120-hour catheterization compared with the initial weight percentage (78.50% ± 6.32%). In the S. aureus incubation test, the antibacterial function of CSS-CVCs was lost after 48 hours [3 (N/D) of OD]. Similar results were observed in a pilot clinical study using 18 CSS-CVCs. Conclusions: We found that the efficacy of CSS-CVCs decreased over time and that the antibacterial function was lost after 48 hours of simulated wear-out. Therefore, antibiotic-impregnated CVCs may be a better option when longer (>48 hours) indwelling is needed.

Original languageEnglish
Pages (from-to)1042-1053
Number of pages12
JournalJournal of International Medical Research
Volume45
Issue number3
DOIs
Publication statusPublished - 2017 Jun 1

Fingerprint

Silver Sulfadiazine
Catheter-Related Infections
Chlorhexidine
Central Venous Catheters
Catheters
Research laboratories
Silver
Catheterization
Staphylococcus aureus
X-Ray Emission Spectrometry
Weights and Measures
Coatings
Local Anti-Infective Agents
Density (optical)
Polyurethanes
Research
Electron Scanning Microscopy
Nanoparticles
Assays
Wear of materials

Keywords

  • Antibacterial activity
  • bloodstream model
  • central line infections

ASJC Scopus subject areas

  • Biochemistry
  • Cell Biology
  • Biochemistry, medical

Cite this

@article{b52dc5775f534f648a923130a34798f0,
title = "Chlorhexidine and silver sulfadiazine coating on central venous catheters is not sufficient for protection against catheter-related infection: Simulation-based laboratory research with clinical validation",
abstract = "Objective: The efficacy of chlorhexidine- and silver sulfadiazine-coated central venous catheters (CSS-CVC) against catheter-related infection remains controversial. We hypothesized that the loss of silver nanoparticles may reduce the antibacterial efficacy of CSS-CVCs and that this loss could be due to the frictional force between the surface of the CVC and the bloodstream. The objective of this study was to investigate whether the antimicrobial effect of CSS-CVCs decreases with increasing exposure time in a bloodstream model and quantitatively assay the antimicrobial effect of CSS-CVCs compared with polyurethane and antiseptic-impregnated CVCs. Methods: Each CVC was subjected to 120 hours of saline flow and analyzed at intervals over 24 hours. The analyses included energy-dispersive X-ray spectroscopy, scanning electron microscopy, and optical density after a Staphylococcus aureus incubation test. Results: The weight percentage of silver in the CSS-CVCs significantly decreased to 56.18{\%} (44.10{\%} ± 3.32{\%}) with 48-hour catheterization and to 18.88{\%} (14.82{\%} ± 1.33{\%}) with 120-hour catheterization compared with the initial weight percentage (78.50{\%} ± 6.32{\%}). In the S. aureus incubation test, the antibacterial function of CSS-CVCs was lost after 48 hours [3 (N/D) of OD]. Similar results were observed in a pilot clinical study using 18 CSS-CVCs. Conclusions: We found that the efficacy of CSS-CVCs decreased over time and that the antibacterial function was lost after 48 hours of simulated wear-out. Therefore, antibiotic-impregnated CVCs may be a better option when longer (>48 hours) indwelling is needed.",
keywords = "Antibacterial activity, bloodstream model, central line infections",
author = "Choi, {Yoon Ji} and Lim, {Jae Kwan} and Park, {Jeong Jun} and Hyub Huh and Kim, {Dong Ju} and Gong, {Chang Hoon} and Seung-Zhoo Yoon",
year = "2017",
month = "6",
day = "1",
doi = "10.1177/0300060517708944",
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journal = "Journal of International Medical Research",
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T1 - Chlorhexidine and silver sulfadiazine coating on central venous catheters is not sufficient for protection against catheter-related infection

T2 - Simulation-based laboratory research with clinical validation

AU - Choi, Yoon Ji

AU - Lim, Jae Kwan

AU - Park, Jeong Jun

AU - Huh, Hyub

AU - Kim, Dong Ju

AU - Gong, Chang Hoon

AU - Yoon, Seung-Zhoo

PY - 2017/6/1

Y1 - 2017/6/1

N2 - Objective: The efficacy of chlorhexidine- and silver sulfadiazine-coated central venous catheters (CSS-CVC) against catheter-related infection remains controversial. We hypothesized that the loss of silver nanoparticles may reduce the antibacterial efficacy of CSS-CVCs and that this loss could be due to the frictional force between the surface of the CVC and the bloodstream. The objective of this study was to investigate whether the antimicrobial effect of CSS-CVCs decreases with increasing exposure time in a bloodstream model and quantitatively assay the antimicrobial effect of CSS-CVCs compared with polyurethane and antiseptic-impregnated CVCs. Methods: Each CVC was subjected to 120 hours of saline flow and analyzed at intervals over 24 hours. The analyses included energy-dispersive X-ray spectroscopy, scanning electron microscopy, and optical density after a Staphylococcus aureus incubation test. Results: The weight percentage of silver in the CSS-CVCs significantly decreased to 56.18% (44.10% ± 3.32%) with 48-hour catheterization and to 18.88% (14.82% ± 1.33%) with 120-hour catheterization compared with the initial weight percentage (78.50% ± 6.32%). In the S. aureus incubation test, the antibacterial function of CSS-CVCs was lost after 48 hours [3 (N/D) of OD]. Similar results were observed in a pilot clinical study using 18 CSS-CVCs. Conclusions: We found that the efficacy of CSS-CVCs decreased over time and that the antibacterial function was lost after 48 hours of simulated wear-out. Therefore, antibiotic-impregnated CVCs may be a better option when longer (>48 hours) indwelling is needed.

AB - Objective: The efficacy of chlorhexidine- and silver sulfadiazine-coated central venous catheters (CSS-CVC) against catheter-related infection remains controversial. We hypothesized that the loss of silver nanoparticles may reduce the antibacterial efficacy of CSS-CVCs and that this loss could be due to the frictional force between the surface of the CVC and the bloodstream. The objective of this study was to investigate whether the antimicrobial effect of CSS-CVCs decreases with increasing exposure time in a bloodstream model and quantitatively assay the antimicrobial effect of CSS-CVCs compared with polyurethane and antiseptic-impregnated CVCs. Methods: Each CVC was subjected to 120 hours of saline flow and analyzed at intervals over 24 hours. The analyses included energy-dispersive X-ray spectroscopy, scanning electron microscopy, and optical density after a Staphylococcus aureus incubation test. Results: The weight percentage of silver in the CSS-CVCs significantly decreased to 56.18% (44.10% ± 3.32%) with 48-hour catheterization and to 18.88% (14.82% ± 1.33%) with 120-hour catheterization compared with the initial weight percentage (78.50% ± 6.32%). In the S. aureus incubation test, the antibacterial function of CSS-CVCs was lost after 48 hours [3 (N/D) of OD]. Similar results were observed in a pilot clinical study using 18 CSS-CVCs. Conclusions: We found that the efficacy of CSS-CVCs decreased over time and that the antibacterial function was lost after 48 hours of simulated wear-out. Therefore, antibiotic-impregnated CVCs may be a better option when longer (>48 hours) indwelling is needed.

KW - Antibacterial activity

KW - bloodstream model

KW - central line infections

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