PROCESS SPECTRUM CATHETERS Proven Lowest Infection Rates
the right combination Minocycline+rifampin is proven to be the most synergistic combination of antibiotics in reducing infections through two distinct pathways, and has the ability to penetrate the biofilm that forms on all indwelling catheters. Zones of Inhibition 1 MRSA Antimicrobial Durability of Minocycline+Rifampin vs. Second Generation Chlorhexidine/Silver Sulfadiazine and Silver/Platinum/Carbon 2 Baseline Spectrum polyurethane 24 mm Uncoated polyurethane mm Edwards Vantex Oligon 14 mm 2 Minocycline/Rifampin Second Generation Chlorhexidine/Silver Sulfadiazine Silver/Platinum/Carbon 9 Day Durability Spectrum polyurethane 2 mm ARROWg + ard Blue PLUS mm Uncoated polyurethane mm Edwards Vantex Oligon mm ARROWg + ard Blue PLUS 8 mm Zones of Inhibition (mm) 1 7 14 Days 21 28 (Tested against MRSA) Coated catheters [that can maintain an in vitro zone of inhibition] 3, citing 4 of mm were highly predictive of in vivo efficacy. Arrowg + ard Blue PLUS and AGB+ are registered trademarks of Teleflex Incorporated. Vantex and Oligon are trademarks of Edwards Lifesciences Corporation.
unmatched evidence In vitro studies show that our M+R catheters maintain an effective zone of inhibition for up to 21 days longer than any other catheters. Over two decades of evidence, including more than 21 peer-reviewed studies and meta-analyses, prove M+R s ability to prevent bloodstream infections. Meta-analyses Comparing Antimicrobial CVCs First Trial of Second Generation AGB+ and Spectrum, Partially Funded by CDC 7 CVCs (n/n) Standard Comparator Silver iontophoretic Moretti et al (2) 66 1/262 /22 14 ( 7 9) 262 Corral et al (23) 1/3 4/3 3 4 ( 8 19 97) NA Total (FEM) 2/36 4/3 1 98 ( 4 9 9) NA Test for heterogeneity: Q=2 11 (1 df), p= ; I 2 =% Second-generation CSS Rupp et al (2) 72 3/393 1/384 38 ( 2 87) 199 Ostendorf et al (2) 68 7/94 3/9 4 ( 13 1 61) 24 Brun-Buisson et al (24) 46 /17 3/188 6 ( 14 2 26) 79 Total (FEM) /662 7/662 47 ( 2 1 ) 4 Test for heterogeneity: Q= 11 (2 df), p= 9; I 2 =% OR OR (9%CI) NNT Process 3.3 8 Process with Ch-SS+ (AGB+) Process with M+R (Spectrum) 2.7 7 1.4 7 Minocycline rifampicin Raad et al (1997) 7 7/136 /13 14 ( 3 61) 19 Marik et al () 6 2/39 /38 14 ( 1 2 2) 2 Chatzinikolaou et al (23) 48 1/64 /66 13 ( 6 61) 64 Leon et al (24) 62 11/18 6/187 2 ( 2 1 37) 34 Hanna et al (24) 14/174 3/182 2 ( 9 6) 16 Total (FEM) 3/93 9/63 29 ( 16 2) 21 Test for heterogeneity: Q=2 93 (4 df), p=1 ; I 2 =% INFECTIONS PER 1, CATHETER DAYS 7, 8 1 1 1 Favours antimicrobial CVC Favours standard CVC CRBSI in trials comparing antimicrobial CVCs with standard CVCs Within each subgroup, the studies are ordered by increasing mean catheter indwell duration. The vertical line represents the null hypothesis of no difference between test and control groups. Odds ratios (ORs) and 9% CIs are shown. Black diamonds indicate the pooled ORs (9% CIs). Results of the Peto fixed-effects model (FEM) are quoted unless substantial heterogeneity is present, in which case the results of the DerSimonian-Laird random-effects model (REM) are stated. NNT=number needed to treat (the expected number of people who need to receive the antimicrobial rather than the standard CVC for one additional person to avoid CRBSI). NA=not applicable (if the estimated OR is 1 ). In our pooled analyses, neither silver-alloy-coated, silver-iontophoretic, nor silver-impregnated CVCs showed any significant reduction in colonisation or CRBSI by comparison with standard CVCs. 6 1.3 Gram Positive..68.68. Gram Negative ANALYSIS OF TYPES OF INFECTION 7 INFECTIONS PER 1, CATHETER DAYS Fungal Ch-SS+ (AGB+) M+R (Spectrum).31
decreased resistance More than years of clinical use has shown no evidence that M+R catheters lead to bacterial resistance, and a seven year study of over, catheter days confirms these results. 9 Data indicate that facilities using M+R catheters have a decreased need for systemic antibiotic use. MRSA: Decrease in Resistance After >, CNS: Decrease in Resistance After >, Catheter Days of Antibiotic Catheter (M+R) Use 11 Catheter Days of Antibiotic Catheter (M+R) Use 11 MRSA CNS % Resistance to Rifampin 3 2 2 P <.1 3 2 P =. 2 12% 12% 11% 4% % Resistance to Tetracycline 7% % Resistance to Rifampin 3 2 2 % Resistance to Tetracycline 3 2 P <.1 P <.1 2 % 2% 14% 26 26 26 26 (n=272) (n=68) (n=291) (n=662) (n=1223) (n=784) (n=1223) (n=784) M/R CVC use is not associated with long term increased staphylococcal resistance to tetracyclines and rifampin; however, it represents a crucial strategy to significantly decrease CRBSI in critically ill cancer patients. 9
worth switching In a challenging clinical environment, a hospital that switches to an M+R impregnated catheter can expect to see a decrease in CRBSI rates, attributable mortality and CRBSI-related costs. What might not be so apparent is that high-performing hospitals can switch to Spectrum to drive incremental improvement in CRBSI rates and still achieve substantial reductions in mortality and cost. Net Reduction of CRBSI/1, Catheter Days Number Needed to Treat to Prevent One CRBSI Savings per Patient Number Needed to Treat to Save One Life. 4 $3. 267 4. $24. 333 3. 67 $18. 444 2. $12. 667 1. 133 $9. 889 1. 2 $6. 1,333. 4 $3. 2,667 Assumptions: catheter days per patient, 1 catheter per patient, $12, incremental cost to treat CRBSI, CRBSI mortality rate of %
References 1. I. Raad, MD, Department of Infectious Disease, M.D. Anderson Cancer Center, University of Texas School of Medicine; Houston, Texas. 2. Hanna H, Bahna P, Reitzel R, et al. Comparative in vitro efficacies and antimicrobial durabilities of novel antimicrobial central venous catheters. Antimicrob Agents Chemother. 26;():3283-3288. 3. Raad I, Darouiche R, Hachem R, et al. Antibiotics and prevention of microbial colonization of catheters. Antimicrob Agents Chemother. 199;39(11):2397-24. 4. Sherertz RJ, Carruth WA, Hampton AA, et al. Efficacy of antibiotic-coated catheters in preventing subcutaneous Staphylococcus aureus infection in rabbits. J Infect Dis. 1993;167(1):98-6.. Reprinted from Lancet Infect Dis 8(12), Casey AL, Mermel LA, Nightingale P, Elliott TS: Antimicrobial central venous catheters in adults: a systematic review and meta-analysis, p. 77, copyright 28, with permission from Elsevier. 6. Casey AL, Mermel LA, Nightingale P, et al. Antimicrobial central venous catheters in adults: a systematic review and meta-analysis. Lancet Infect Dis. 28;8(12):763-776. 7. Schuerer DJ, Mazuski JE, Buchman TG, et al. Catheter-related bloodstream infection rates in minocycline/rifampin vs. chlorhexidine/silver sulfadiazine-impregnated central venous catheters - results of a 46 month study. Crit Care Med. 28;36(12) (suppl):a199-a28. Abstract 44. 8. Schuerer D, Zack JE, Thomas J, et al. Effect of chlorhexidine/silver sulfadiazine-impregnated central venous catheters in an intensive care unit with a low blood stream infection rate after implementation of an educational program: a before-after trial. Surg Infect (Larchmt). 27;8(4):44-44. 9. Ramos E, Jiang Y, Hachem R, et al. Is the prolonged use of minocycline/rifampin coated catheters (M/R CVC) associated with increased resistance: a seven year experience in a tertiary cancer center. Paper presented at: SHEA 18th Annual Scientific Meeting; April -8, 28; Orlando, FL.. Brooks K, Dauenhauer S, Nelson M. Comparison of an untreated vs. silver/chlorhexidine vs. rifampin/minocycline central venous catheter in reducing catheter-related bloodstream infections. Abstract presented at: APIC 28th Annual Educational Conference and International Meeting; June -14, 21; Seattle, WA. 11. Ramos ER, Jiang Y, Hachem R, et al. The risk of emerging resistance associated with prolonged use of antibiotic coated catheters: a seven year experience and >. million catheter days. Poster presented at: Society for Healthcare Epidemiology of America (SHEA) 18th Annual Scientific Meeting; April -8, 28; Orlando, FL. Dr. Raad is the co-inventor of the synergistic pairing of the antibiotics minocycline and rifampin that are impregnated within the catheter material of the Cook Spectrum catheter. His institution receives a royalty payment based upon Cook s license to use this patented technology. COOK MEDICAL INCORPORATED P.O. Box 419, Bloomington, IN 4742-419 U.S.A. Phone: 812.339.223, Toll Free: 8.47.4, Toll Free Fax: 8.4.833 COOK (CANADA) INC. 111 Sandiford Drive, Stouffville, Ontario, L4A 7X CANADA Phone: 9.64.71, Toll Free: 8.668.3 www.cookmedical.com WILLIAM A. COOK AUSTRALIA PTY. LTD. 9 Brandl Street, Brisbane Technology Park, Eight Mile Plains Brisbane, QLD 4113 AUSTRALIA, Phone: +61 7 3841 1188 WILLIAM COOK EUROPE ApS Sandet 6, DK-4632, Bjaeverskov, DENMARK, Phone: +4 6 86 86 86 COOK 2 CC-BE-ABRMRR-EN-2 AORTIC INTERVENTION CRITICAL CARE ENDOSCOPY INTERVENTIONAL RADIOLOGY LEAD MANAGEMENT PERIPHERAL INTERVENTION SURGERY UROLOGY WOMEN S HEALTH