Prolonged Antimicrobial Activity of a Catheter Containing Chlorhexidine-Silver Sulfadiazine Extends Protection against Catheter Infections In Vivo

ABSTRACT The present study evaluated in vitro and in vivo a new chlorhexidine (C)-silver sulfadiazine (S) vascular catheter (the CS2 catheter) characterized by a higher C content and by the extended release of the surface-bound antimicrobials. The CS2 catheter was compared with a first-generation, commercially available CS catheter (the CS1 catheter). The CS2 catheter produced slightly smaller zones of inhibition (mean difference, 0.9 mm [P < 0.001]) at 24 h against Staphylococcus aureus and five other microorganisms by several different methodologies. However, in a rabbit model, both CS catheters were similarly efficacious in preventing a catheter infection when the rabbits were inoculated with 104 to 107 CFU of S. aureus at the time of catheter insertion. The CS2 catheter retained its antimicrobial activity significantly longer in vitro and in vivo (half-lifes exceeded 34 and 7 days, respectively) and was also significantly more efficacious in preventing a catheter infection when 106 CFU of S. aureus was inoculated 2 days after catheter implantation (P < 0.001). These results suggest that prolonged anti-infective activity on the external catheter surface provides improved efficacy in the prevention of infection.