***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: PURPOSE To determine whether silver-coated tunneled hemodialysis catheters reduce infection and to determine the frequency of central venous thrombosis and  stenosis  with percutaneous placement of right internal jugular vein dialysis catheters by interventional radiologists . MATERIAL S AND METHODS Ninety-one patients were r and omly assigned to a treatment ( silver-coated catheter ; n = 47 ) or control  ( identical catheter without silver coating ; n = 44 ) arm . Baseline venography was performed . Catheter tips were cultured and venography was repeated at catheter removal . RESULTS Mean duration of catheter placement was 92 days . Infection occurred in 11 patients ( five in the treatment group , six in the control group ) . Tip cultures in 15 patients ( eight treatment , seven control ) were positive without clinical infection . Infection and colonization rates were slightly but not significantly higher in the treatment group than in the control group . Silver-coated catheters in two ( 4 % ) patients were removed due to reaction to the coating . Completion venograms ( n = 72 ) showed new minor abnormalities in four ( 6 % ) patients and major abnormalities ( stenosis , thrombosis ) in three ( 4 % ) patients . Permanent venous abnormalities occurred in two ( 3 % ) patients . CONCLUSION Silver coating does not confer a benefit against clinical infection or colonization . Interventional radiologic placement of tunneled dialysis catheters yields a low frequency of permanent central venous thrombosis and stenosis OBJECTIVE To compare the incidence of and factors associated with vascular thrombosis after placement of heparin-bonded and st and ard femoral venous catheters . DESIGN Prospect i ve , masked , clinical study . SETTING Multidisciplinary , tertiary , pediatric intensive care unit . PATIENTS Consecutive cases ( n = 50 ) of critically ill children admitted to a pediatric intensive care unit in whom either a heparin-bonded ( n = 25 ) or a st and ard ( n = 25 ) femoral venous catheter was placed .  MEASUREMENTS AND MAIN RESULTS Patients were examined by ultrasonography within 3 days of catheter insertion , weekly while the catheter was in place , and after catheter removal for evidence of vascular thrombosis . Data were collected prospect ively regarding clinical evidence of catheter thrombosis , infusate composition , and positive blood culture results . Of 50 patients , 13 ( 26 % ) had thrombotic complications , 11 ( 44 % ) of the 25 patients in the st and ard-catheter group , in comparison with 2 ( 8 % ) of the 25 patients in the heparin-bonded catheter group ( p = 0.004 ) . In addition , there was a significantly higher incidence of positive blood culture results among patients in the st and ard-catheter group ( 24 % vs 0 % ; p = 0.009 ) . Positive catheter blood culture results were obtained in 38 % of patients with thrombosis versus 3 % without thrombosis ( p = 0.001 ) . Clinical evidence of thrombosis was found in 69 % of patients with , versus 27 % of patients without , ultrasound-proved thrombosis ( p = 0.007 ) . CONCLUSION Heparin bonding of catheters is associated with significantly fewer thrombotic complications . A reduced incidence of positive catheter-related blood culture results may be associated with the absence of thrombosis The objective of the study was to evaluate the effectiveness of chlorhexidine-impregnated sponges for reducing catheter-related infections of central venous catheters inserted for cancer chemotherapy . The method used was a r and omized , prospect i ve , open , controlled clinical study ( three-step group sequential analysis protocol ) . The patients were from two high dependency units at a university hospital undergoing chemotherapy for haematological or oncological malignancies requiring central venous catheters ( CVCs ) expected to remain in place for at least 5 days . Six hundred and one patients with 9,731 catheterization days were studied between January 2004 and January 2006 . Patients admitted for chemotherapy received chlorhexidine and silver sulfadiazine-impregnated triple-lumen CVCs under st and ardized conditions and were r and omized to the groups receiving a chlorhexidine gluconate-impregnated wound dressing or a st and ard sterile dressing . Daily routine included clinical assessment of the insertion site ( swelling , pain , redness ) , temperature , white blood count and C-reactive protein . Catheters remained in place until they were no longer needed or when a CVC-related infection was suspected . Infection was confirmed with blood cultures via the catheter lumina and peripheral blood cultures according to the time-to-positivity method . Six hundred and one patients were included . The groups were comparable with respect to demographic and clinical data . The incidence of CVC-related infections were 11.3 % ( 34 of 301 ) and 6.3 % ( 19 of 300 ) in the control and chlorhexidine-impregnated wound dressing groups , respectively ( p = 0.016 , relative risk 0.54 ; confidence interval 0.31–0.94 ) . Especially , catheter-related infections at internal jugular vein insertions could be reduced ( p = 0.018 ) . No adverse effects related to the intervention were observed . The use of chlorhexidine-impregnated wound dressings significantly reduced the incidence of CVC-related infections in patients receiving chemotherapy BACKGROUND Central venous catheter (CVC)-related infections are a substantial problem in the intensive care unit ( ICU ) . Our infection control team initiated the routine use of antiseptic-coated ( chlorhexidine-silver sulfadiazine ; Chx-SS ) CVCs in our adult ICUs to reduce catheter-associated ( CA ) and catheter-related ( CR ) blood stream infection ( BSI ) as we implemented other educational and best practice st and ardization strategies . Prior r and omized studies documented that the use of Chx-SS catheters reduces microbial colonization of the catheter compared with an uncoated st and ard ( Std ) CVC but does not reduce CR-BSI . We therefore implemented the routine use of uncoated Std CVCs in our surgical ICU ( SICU ) and examined the impact of this change . HYPOTHESIS The use of uncoated Std CVCs does not increase CR-BSI rate in an SICU . METHODS Prospect i ve evaluation of universal use of uncoated Std CVCs , implemented November 2007 in the SICU . The incidences of CA-BSI and CR-BSI were compared during November 2006-October 2007 ( universal use of Chx-SS CVCs ) and November 2007-October 2008 ( universal use of Std CVCs ) by t-test . The definitions of the U.S. Centers for Disease Control and Prevention were used for CA-BSI and CR-BSI . Patient data were collected via a dedicated Acute Physiology and Chronic Health Evaluation ( APACHE ) III coordinator for the SICU . RESULTS Annual use of CVCs increased significantly in the last six years , from 3,543 ( 2001 ) to 5,799 ( 2006 ) total days . The APACHE III scores on day 1 increased from a mean of 54.4 in 2004 to 55.6 in 2008 ( p = 0.0010 ; 95 % confidence interval [ CI ] 1.29 - 5.13 ) . The mean age of the patients was unchanged over this period , ranging from 58.2 to 59.6 years . The Chx-SS catheters were implemented in the SICU in 2002 . Data regarding the specific incidence of CR-BSI were collected beginning at the end of 2005 , with m and atory catheter tip cultures when CVCs were removed . Little difference was identified in the incidence of BSI between the interval with universal Chx-SS use and that with Std CVC use . ( Total BSI 0.7 vs. 0.8 per 1,000 catheter days ; CA-BSI 0.5 vs. 0.8 per 1,000 catheter days ; CR-BSI 0.2 vs. 0 per 1,000 catheter days . ) No difference was seen in the causative pathogens of CA-BSI or CR-BSI . CONCLUSION Eliminating the universal use of Chx-SS-coated CVCs in an SICU with a low background incidence of CR-BSIs did not result in an increase in the rate of CR-BSIs . This study documents the greater importance of adherence to st and ardization of the processes of care related to CVC placement than of coated CVC use in the reduction of CR-BSI Objective : To determine whether heparin bonding reduces the incidence of catheter-related thrombosis and infection in critically ill children . Design : A prospect i ve double-blind r and omized controlled study . Setting : A tertiary paediatric intensive care unit . Patients : Two hundred and nine patients , 123 males and 86 females , aged 0–16 years , admitted to the intensive care unit and needing a central venous line ( CVL ) , were r and omized to receive either a heparin-bonded ( HB  , n = 102 ) or a non-heparin-bonded line ( NHB , n = 107 ) . Nine patients were excluded owing to incomplete data . Intervention : HB or NHB CVL . Measurements : Blood cultures were carried out on insertion of the line and every 3 days thereafter . Ultrasound was performed within the first 3 days and every 3 days thereafter . On removal the line was sent for culture . Results : The two groups were comparable for age , sex , severity of illness and length of time that the catheter was in situ . Proportional hazards modelling showed that heparin bonding was associated with a significant reduction in infections ( hazard ratio 0.11 , P < 0.00 005 ) . The incidence of infection was 4 % and 33 % in HB and NHB CVLs , respectively ( 4/97 vs. 34/103 , P < 0.0005 ) . The incidence of thrombosis was 0 % and 8 % in HB and NHB CVLs , respectively ( 0/97 vs. 8/103 , P = 0.006 ) . The number of HB CVLs which would need to be used to avoid one episode of infection or thrombosis was 3 and 13 , respectively . Conclusion : Our study shows a significant reduction in the incidence of infection and thrombosis associated with the use of HB CVLs OBJECTIVE To evaluate the incidence of nosocomial bacteremias related to the use of  non-impregnated central venous catheters ( CVCs )  when only non-technologic strategies were used to prevent them . DESIGN This was a prospect i ve study of infectious complications of CVCs placed in intensive care unit ( ICU ) patients from April 1997 to December 2001 . SETTING The medical-surgical ICU of a tertiary-care , university-affiliated hospital in Argentina . METHODS We studied all patients admitted to the ICU using non-impregnated CVCs . Maximal sterile barrier pre caution s ( ie , use of cap , mask , sterile gown , sterile gloves , and large sterile drape ) , strict h and washing , preparation of the patients ' skin with antiseptic solutions , insertion and management of catheters by trained personnel , and continuing quality improvement programs aim ed at appropriate insertion and maintenance of catheters were employed . RESULTS During the study period , 2,525 patients were admitted to the ICU . Eight hundred sixty-eight patients had 1,037 CVCs inserted . The number of CVC-related bloodstream infections ( BSIs ) , acquired in the ICU , was 2.7 per 1,000 CVC-days ( 13 nosocomial CVC-related BSIs during 4,770 days of CVC use ) . Microorganisms isolated included methicillin-susceptible Staphylococcus aureus ( n = 6 ) , methicillin-resistant S. aureus ( n = 2 ) , coagulase-negative methicillin-resistant Staphylococcus ( n = 2 ) , Escherichia coli ( n = 1 ) , Klebsiella pneumoniae ( n = 1 ) , and Enterobacter cloacae ( n = 1 ) . CONCLUSIONS A low rate of catheter-related BSI was achieved without antimicrobial-impregnated catheters . The incidence of CVC-associated bacteremias corresponded to the 10th to 20th percentile range of the National Nosocomial Infections Surveillance System hospitals for the same type of ICU OBJECTIVE To evaluate the impact of using central venous catheters ( CVCs ) impregnated with the combination of minocycline and rifampin on  nosocomial bloodstream infections ( BSIs ) , morbidity , and mortality in cancer patients in the ICU . DESIGN Prospect i ve surveillance study consisting of the following two time periods : September 1997 through August 1998 ( ie , fiscal year [ FY ] 1998 ) ; and from September 1998 through August 1 
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However , catheter impregnation made no significant difference to the rates of clinical ly diagnosed sepsis ( RR 1.0 ( 95 % CI 0.88 to 1.13 ) ) and all-cause mortality ( RR 0.88 ( 95 % CI 0.75 to 1.05)).In our subgroup analyses , we found that the magnitudes of benefits for impregnated CVCs varied in studies that enrolled different types of participants .
However , there was no such variation for the outcome of CRBSI .
The magnitude of the effects was also not affected by the participants ' baseline risks .
There were no significant differences between the impregnated and non-impregnated groups in the rates of adverse effects , including thrombosis/thrombophlebitis , bleeding , erythema and /or tenderness at the insertion site .
AUTHORS ' CONCLUSIONS This review confirms the effectiveness of antimicrobial CVCs in improving such outcomes as CRBSI and catheter colonization .
However , the magnitude of benefits in catheter colonization varied according to the setting , with significant benefits only in studies conducted in ICUs .
Limited evidence suggests that antimicrobial CVCs do not appear to significantly reduce clinical ly diagnosed sepsis or mortality .