09.00 09.30 mark rupp - publiceren

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09.00 09.30 mark rupp - publiceren

  1. 1. Srinivasan A, et al. MMWR 60: 2011; CDC BHSN 2010 Data Summary; Umscheid CA, et al. Infect Control Hosp Epidemiol. 2011; 32:101-114.Scott RD. Division of Healthcare Quality Promotion, CDC, 2009.
  2. 2. CHG/SS M/R Silver/Platinum/ Carbon (Silver Iontophoretic; Vantex) Hydrocath Assure (BD) Benzalkonium AMC Thromboshield (Edwards)Multistar Benzalkonium HeparinMiconazole/Rifampin(Vygon)
  3. 3. Staphylococcus epidermidisC/S CS/C/P M/R Spangler & Moss, Arrow International
  4. 4. Pseudomonas aeruginosa Candida albicans C/S C/S C C S/C/P M/R S/C/P M/R Spangler & Moss, Arrow InternationalCH/SS: Poor activity vs Acinetobacter,Stenotrophomonas, Enterobacter
  5. 5. Meta Analysis Medline search of articles with “meta-analysis” in title, 2007-2011  Quality of Reporting of Meta-Analysis (QUORUM) guidelines
  6. 6. BSI Silver Alloy (0.58) Silver Iontoph (1.98) Silver Impreg (0.93) BenzChl (1.0) Colonization Silver Alloy (1.21) Rif/Micon (0.14)Casey AL, et al. Lancet ID, 2008
  7. 7. Ramritu AJIC 2008Scatter plot of 29 studies (BSI vs. colonization)Spearman Correlation coefficient:r = 0.63, r2 = 0.4; P = 0.003
  8. 8. Do antimicrobial-coated catheters prevent BSI? 4.2% 0.68 0.47 2.3% 0.29 5.9% Casey AL, et al. Lancet ID, 2008
  9. 9. S. aureus S. epidermidis1st & 2nd generation CH/SS CVCs 2nd generation CH/SS CVC 2 (58 explanted CVCs) 1 Bassetti, et al AAC 2001 Fey et al, ICAAC, 2000 Duration of activity of M/R appears to be greater than CH/SS
  10. 10. Chest, 2004
  11. 11. Crit Care Med, 2011
  12. 12. Veenstra DL, et al. JAMA 1999 Shorr AF, et al. Chest 2003Marciante KD, et al. AJIC 2003
  13. 13. Conclusions from Cost Effectiveness StudiesVeenstra DL, et al. JAMA 1999“…the use of chlorhexidine-silver sulfadiazine impregnated cathetersin patients at high risk for infection reduces the incidence of CR-BSIand death and provides significant saving in costs.”Shorr AF, et al. Chest 2003“Utilization of antiseptic and antibiotic-impregnated CVCs representan attractive alternative for prevention of CRBSIs and may lead tosignificant savings. … the RM CVC performs better financially.”Marciante KD, et al. AJIC 2003“CVCs coated with M/R are cost effective for patients catheterizedfor at least one week and lead to overall cost savings when patientsare catheterized for 2 weeks or longer.”
  14. 14. Health Technology Assessment, 2008
  15. 15. Crit Care, 2009
  16. 16. (MRSA) GND X M/R * CH/SS SPC
  17. 17. Spectrum of ActivityMRSA P.aer C. albicans C. glabrata Uncoated M/R CH-M/R CH/SS Durability vs MRSA Uncoated M/R CH-M/R CH/SS
  18. 18. Kaplan Meier analysis of colonization Walz, et al. Crit Care Med, 2010

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