Antibiotic coated tubes could reduce infection rates of children in intensive care

Coating the plastic tubing that is used to give life-saving drugs and fluids into a child’s vein with antibiotics could help to prevent bloodstream infections developing in children in intensive care, reports teams from the UCL Institute of Child Health and Great Ormond Street Hospital.Reducing the number of these infections would mean fewer children in intensive care would suffer consequences such as septic shock or damage to the brain and other organs.

The work was carried out in collaboration with 14 other hospitals in the UK and is one of over 1000 research projects currently being carried out at Great Ormond Street Hospital and the UCL Institute of Child Health as part of their pioneering research programme, which aims to improve the treatment and care of children and adolescents.

When patients arrive in intensive care, a tube, called a central venous catheter, is inserted in to large veins in the body in order to deliver nutrition and drugs. These tubes are made from a plastic which can be a magnet for bacteria to cling to, leading to infections in the bloodstream. Infections can also occur when blood clots in and around the tube – a particular problem for children, who need very narrow tubes due to their small veins. These infections can lead to damage to the brain and other organs, and previous studies have shown that bloodstream infection also increase mortality rates and lead to longer stays in intensive care units.

Researchers had previously discovered that coating the polyurethane catheters both inside and out with low levels of antibiotics or the blood thinning drug heparin, can stop bacteria from latching on to the catheter, reducing the chances of bacteria infecting the catheter and circulating in the blood. Trials of these catheters in adult patients in intensive care showed that they decreased infections by 70-80%. To date, no trial of antibiotic or heparin coated tubes had been carried out in children.

Now, Ruth Gilbert and colleagues report in The Lancet a study of 1485 children on intensive care units across the UK. The team wanted to see whether the number of bloodstream infections caused by venous catheters differed when using a standard catheter compared with an antibiotic or heparin coated catheter.

They found that 4% of patients who used the standard central venous catheter developed bloodstream infections, in line with levels seen normally, and 3% of patients in the heparin group also developed an infection. However, only 1% of patients in the antibiotic coated group developed a bloodstream infection – a significant decrease. The authors noted that the different catheters did not affect mortality rates but they did have a significant impact on numbers of infections.

They also carried out an assessment to consider how cost effective widespread use of the catheters across the NHS may be. From this, they discovered using the catheters could reduce the costs of caring for children while they are hospitalised and need intensive care.”

The work therefore suggests that, in children, antibiotic coated catheters may offer protection to patients in intensive care in the same way as they do for adults.

Quen Mok, Consultant in Intensive care at Great Ormond Street Hospital and one of the authors of the work, says: “Bloodstream infections can be dangerous for children who are already very sick. They can make conditions worse and even cause death and so ways to reduce the infection risk to our patients in intensive care would be very welcome.”

Lead author, Ruth Gilbert, Professor of Clinical Epidemiology at the UCL Institute of Child Health says: “Our results suggest that adoption of antibiotic coated catheters across the NHS could reduce numbers of children with bloodstream infection and be beneficial to both individual patients and the NHS as a whole.”

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00340-8/abstract

Related Health Technology Assessment http://www.journalslibrary.nihr.ac.uk/hta

This article presents independent research funded by the National Institute for Health Research (NIHR). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.