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Antibiotic-coated catheters may select for resistant gram-negative bacteria and Candida organisms.
True
At least two prospective in vivo studies show that the use of antimicrobials with a limited spectrum of activity may lead to the growth of pathogens that they do not protect against.(1,2) For example, in their study of antibiotic catheters in a critical care setting, Wright et al. found “antibiotic-coated central lines were not associated with any benefit in this critically ill patient population. They were associated with increased Candida colonization and the development of rifampin resistance to Staphylococcus epidermidis.” (1) And in a multicenter trial in Spain, León et al. observed that minocycline rifampin (MR) catheters were associated with “a significant increase in Candida spp. colonization.”(2)
An in vitro study by Hanna et al. echoes many of the findings stated above, and includes a strong cautionary note (underlines added for emphasis):
“Although the antibiotic-coated M/R-CVCs have been shown through a number of prospective randomized clinical trials to be highly efficacious in preventing CRBSI in short-term and long-term CVCs, there are several concerns associated with their use. The first is their limited antimicrobial durability and activity against the adherence of resistant gram-negative bacteria, such as P. aeruginosa, or Candida species, e.g., C. albicans and C. parapsilosis … Although P. aeruginosa and Candida spp. are the causes of 3% and 10% of all CRBSI, respectively, they are, however, associated with high morbidity and mortality. Furthermore, although antibiotic-coated CVCs are highly effective in the clinical setting, there is a potential for these devices to select for resistant gram-negative bacteria and Candida organisms, leading to breakthrough bacteremias and fungemias . Another concern is the emergence of resistant bacteria with decreased susceptibility to either minocycline or rifampin. In a prospective cohort of medical/surgical ICU patients, antibiotic-coated CVCs were found to be associated with increased colonization with Candida and with the emergence of rifampin-resistant Staphylococcus epidermidis.” (3)
REFERENCES:
(1) Wright, F., Heyland, D.K., Drover, J.W., McDonald, S., Zoutman, D. “Antibiotic-Coated Central Lines: Do They Work in the Critical Care Setting?” Clinical Intensive Care, February 1, 2001, Vol. 12, pp. 21–28.
(2) León, C., Ruiz-Santana, S. “Benefits of Minocycline and Rifampin-impregnated Central Venous Catheters: A Prospective, Randomized, Double-blind, Controlled, Multicenter Trial.” Journal of Intensive Care Medicine, October, 2004, Vol. 30, No. 10, pp. 1891–1899.
(3) Hanna, H., Bahna, P., Reitzel, R., Dvorak, T., Chaiban, G., Hachem, R., Raad, I. “Comparative in vitro Efficacies and Antimicrobial Durabilities of Novel Antimicrobial Central Venous Catheters.” Antimicrobial Agents and Chemotherapy, Oct. 2006, pp. 3283–3288.
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