spectrum spectrum

PROCESS
SPECTRUM
CATHETERS
Proven Lowest Infection Rates
horizontal icons/positive
2 line type
PMS 158/c0m61y97k0
horizontal icons/negative
2 line type
PMS 158/c0m61y97k0
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.
Antimicrobial Durability of Minocycline+Rifampin vs. Second Generation
Chlorhexidine/Silver Sulfadiazine and Silver/Platinum/Carbon2
Zones of Inhibition1
MRSA
Baseline
Minocycline/Rifampin
Second Generation
Chlorhexidine/Silver Sulfadiazine
Uncoated polyurethane
0 mm
Spectrum
polyurethane
24 mm
Edwards Vantex™ Oligon™
14 mm
9 Day Durability
Uncoated polyurethane
0 mm
Spectrum
polyurethane
vertical icons/positive
25 mm
2 lines type
Edwards Vantex™ Oligon™
0 mm
Zones of Inhibition (mm)
ARROWg+ard Blue PLUS®
15 mm
15
10
5
0
PMS 158/c0m61y97k0
ARROWg ard Blue PLUS®
8 mm
+
Silver/Platinum/Carbon
20
1
7
14
21
28
Days
(Tested against MRSA)
“Coated catheters [that can maintain an in vitro zone of inhibition]
of ≥ 15 mm were highly predictive of in vivo efficacy.” 3, citing 4
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.
First Trial of Second Generation AGB+®
and Spectrum, Partially Funded by CDC7
Meta-analyses Comparing Antimicrobial CVCs5
CVCs (n/N)
Standard
Silver iontophoretic
Moretti et al (2005)66
1/262
Corral et al (2003)50
1/103
Total (FEM)
2/365
Test for heterogeneity: Q=2·11 (1 df), p=0·15; I2=0%
OR
OR (95%CI)
NNT
Comparator
0/252
4/103
4/355
0·14 (0·00–7·09) 262
3·40 (0·58–19·97) NA
1·98 (0·40–9·95) NA
Second-generation CSS
Rupp et al (2005)72
3/393
1/384
Ostendorf et al (2005)68
7/94
3/90
Brun-Buisson et al (2004)46
5/175
3/188
Total (FEM)
15/662
7/662
icons/positive
Test for heterogeneity: Q=0·11 (2 df), p=0·95; I2=0%
Process with
M+R
(AGB+)
3.38
(Spectrum)
2.77
0·38 (0·05–2·87) 199
0·45 (0·13–1·61)
24
0·56 (0·14–2·26)
79
0·47 (0·20–1·10) 154
vertical
2 lines type
PMS 158/c0m61y97k0
Minocycline–rifampicin
Raad et al (1997)70
7/136
0/130
Marik et al (1999)65
2/39
0/38
48
Chatzinikolaou et al (2003)
1/64
0/66
Leon et al (2004)62
11/180
6/187
Hanna et al (2004)55
14/174
3/182
Total (FEM)
35/593
9/603
Test for heterogeneity: Q=2·93 (4 df), p=1·00; I2=0%
0·01
Process with
Ch-SS+
Process
0·14 (0·03–0·61)
0·14 (0·01–2·20)
0·13 (0·00–6·61)
0·52 (0·20–1·37)
0·25 (0·09–0·65)
0·29 (0·16–0·52)
0·1
Favours antimicrobial CVC
1·0
10
Favours standard CVC
1.47
19
20
64
34
16
21
INFECTIONS PER 1,000 CATHETER DAYS7, 8
Ch-SS+
100
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 95% CIs are shown. Black diamonds indicate the pooled ORs (95% 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 ≥1·0).
“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
1.35
(AGB+)
M+R
(Spectrum)
.55
.68
.55
.68
.31
vertical icons/negative
2 lines type
PMS 158/c0m61y97k0
Gram
Positive
Gram
Negative
ANALYSIS OF TYPES OF INFECTION 7
INFECTIONS PER 1,000 CATHETER DAYS
Fungal
decreased resistance
More than 10 years of clinical use has shown no evidence that M+R
catheters lead to bacterial resistance, and a seven year study of
over 500,000 catheter days confirms these results.9 Data indicate
that facilities using M+R catheters have a decreased need for
systemic antibiotic use.10
CNS: Decrease in Resistance After > 500,000
Catheter Days of Antibiotic Catheter (M+R) Use11
MRSA: Decrease in Resistance After > 500,000
Catheter Days of Antibiotic Catheter (M+R) Use11
MRSA
12%
10
4%
5
vertical icons/negative
2 lines type
PMS 158/c0m61y97k0
1999
2006
(n=272)
(n=658)
25
P = .015
20
15
12%
10
7%
5
0
1999
2006
(n=291)
(n=662)
% Resistance to Rifampin
P < .001
20
% Resistance to Tetracycline
% Resistance to Rifampin
25
0
30
30
30
15
CNS
30
25
P < .001
20
15
11%
10
5%
5
0
1999
2006
(n=1223)
(n=784)
% Resistance to Tetracycline
vertical icons/positive
2 lines type
PMS 158/c0m61y97k0
25
25%
P < .001
20
14%
15
10
5
0
1999
2006
(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/1,000
Catheter Days
Number Needed to Treat
to Prevent One CRBSI
Savings per Patient
Number Needed to Treat
to Save One Life
5.0
40
$300.00
267
4.0
50
$240.00
333
3.0
67
$180.00
444
2.0
100
$120.00
667
1.5
133
$90.00
889
1.0
200
$60.00
1,333
0.5
400
$30.00
2,667
Assumptions: 5 catheter days per patient, 1 catheter per patient, $12,000 incremental cost to treat CRBSI, CRBSI mortality rate of 15%
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. 2006;50(10):3283-3288.
3. Raad I, Darouiche R, Hachem R, et al. Antibiotics and prevention of microbial
colonization of catheters. Antimicrob Agents Chemother. 1995;39(11):2397-2400.
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):98-106.
5. 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. 770, copyright © 2008, 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. 2008;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. 2008;36(12)
(suppl):A199-A208. Abstract 454.
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). 2007;8(4):445-454.
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
5-8, 2008; Orlando, FL.
10. 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 10-14, 2001; 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 > 0.5
million catheter days. Poster presented at: Society for Healthcare Epidemiology of
America (SHEA) 18th Annual Scientific Meeting; April 5-8, 2008; 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 4195, Bloomington, IN 47402-4195 U.S.A.
Phone: 812.339.2235, Toll Free: 800.457.4500, Toll Free Fax: 800.554.8335
COOK (CANADA) INC.
111 Sandiford Drive, Stouffville, Ontario, L4A 7X5 CANADA
Phone: 905.640.7110, Toll Free: 800.668.0300
www.cookmedical.com
WILLIAM A. COOK AUSTRALIA PTY. LTD.
95 Brandl Street, Brisbane Technology Park, Eight Mile Plains
Brisbane, QLD 4113 AUSTRALIA, Phone: +61 7 3841 1188
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