Antibiotic-coated central lines: do they work in the critical care setting?
Bibliographic record
Abstract
Objective: Recent randomized trials have reported that central lines coated with antibiotics decrease catheter colonization and catheter-related bloodstream infection. The purpose of this study was to determine if their use had any effect on catheter colonization, catheter-related bloodstream infections and antimicrobial sensitivities in the critical care setting. Design: A prospective cohort with historical controls Setting: A medical/surgical ICU at a university-affiliated, tertiary care hospital. Patients: Consecutive patients admitted to the ICU requiring central venous access. Intervention: During 1998 data had been prospectively collected on colonized central lines or suspected blood-stream infections. On 1 February 1999, antibiotic-coated central lines were introduced into our ICU for regular use and standard surveillance systems continued. Main outcome measures: Catheter colonization, catheter-related blood stream infection, susceptibility patterns, and line clotting rates. Results: There was no difference in characteristics in the patient populations in 1998 and 1999. In 1998, 96 of 267 (36%) central lines were sent for culture compared with 51 of 142 (36%). Of the 96 line tips that were cultured in 1998; 53 (55%) had organism growth. Of the 51 line tips that were cultured in 1999; 28 (55%) had organism growth (p=0.89). When just organisms that had greater than 15 colony-forming units of growth were compared across years, there was a significant increase in the number of line tips colonized with Candida species associated with the antibiotic-coated central lines (7.5% vs 25%, p=0.03). There were three catheter-related blood stream infections each year. Staphylococcus epidermidis resistant to rifampin was isolated in 3/12 (25%) cases in 1998 and 8/8 (100%) in 1999 (p=0.005). The occlusion rate of the antibiotic-coated catheters was 45% and resulted in the premature termination of this study. Conclusions: 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. Luminal occlusion rates of these catheters limited their clinical utility.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.025 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.000 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".