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A Randomized, Controlled Trial

R. H. Flowers III, MD; Karen J. Schwenzer, MD; Robert F. Kopel, MD; Michael J. Fisch; Sally I. Tucker, MD; Barry M. Farr, MD

JAMA. 1989;261(6):878-883.

Abstract
We performed a randomized controlled trial of an attachable subcutaneous cuff for the prevention of central vascular catheter-related infection among patients receiving intensive care. Catheters were placed percutaneously into new sites with or without a cuff and were dressed with polyantibiotic ointment containing polymyxin, neomycin, and bacitracin. Microbial colonization developed in 34.5% of 29 control and 7.7% of 26 cuffed catheters. Catheter-related bloodstream infection occurred with 13.8% of control vs 0% of cuffed catheters. The cuff was not associated with adverse effects. An unexpectedly large proportion (75%) of catheter infections were due to Candida albicans. This may have been due, in part, to the use of polyantibiotic ointment, as suggested by a pooled analysis of previous trials that demonstrated increased Candida colonization of catheters with the ointment, which is not fungicidal. These data suggest that the cuff can reduce the incidence of catheter-related infection among high-risk patients receiving catheter site care with an antibacterial ointment.

(JAMA 1989;261:878-883)

Author Affiliations
From the Departments of Medicine (Drs Flowers, Tucker, and Farr and Mr Fisch) and Anesthesiology (Drs Schwenzer and Kopel), University of Virginia, Charlottesville.

Footnotes
Read in part before the 15th Annual Educational Conference of the Association for Practitioners in Infection Control, Dallas, May 1-6,1988.

Reprint requests to Department of Internal Medicine, PO Box 473, University of Virginia Medical Center, Charlottesville, VA 22908 (Dr Farr).

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