567 [ ie'/U['.!1!320 4 -fiJ 1 98 (jif.4fj , l mHfi : 70 )VA..:f-:/ v Foley tJ 7- - 7- )VO) -:> (::tiE: t:3J1.l'Wtf(1) ill m_ fTJ;lt- ita· t: .>f- Tl e /ACf:1HiJiilt'l; • iffiMe/A) m ;If JC rt. • m R: j'} (MU • J, in ffiitffHiJiilt'l; (fllW: • !R.z "Jl:.A·;kgg BA • !HZ). EFFICACY OF A LATEX FOLEY CATHETER WITH SUSTAINED RELEASE OF CHLORHEXIDINE: 1ST REPORT: CLINICAL TRIALS FOR PREVENTION OF URINARY TRACT INFECTION Hiroshi NAKANO, ShOllZOU SEKO, Tooru and Hiromi NIHIRA From the Department of Urology, llir05hima UniV(f5ity School of Medicine (Dimtor: Prof. H. Nihria) Motohiro FUJII and KATSUHlKO OKADA From the Urological Clinic, llir05hima General i105pital (Chief: Dr. M. Fujii) Taiji KITAKO From the Urological Clinic, Futami Cmtral i105pital (Chicj: Dr. T. A'i/ano) r-.1itsuo Yoshio OHNlsm and Takuya OKUTAJ'I From /he Urological Clinic, OJlomichi Cmeral llo5pi/al (Chicj: Dr. M. Kodama) ,: Seventy five patients requiring urethral catherization for over 2'1 hours \,'ere treated with a latex Foley catheter with sustained release of chlorhexidine in a closed drainage system. While the catheter was indwell, urinary concentrations of chlorhexidine were maintained at the level of I to 2flg/ml in average in almost al/ patients. The catheter WaS highly effective in preventing the acquisition of catheter-associated bac- teriuria in patients with initially sterile urine without systemic antimicrobial therapy. The aquisition rate of bacteriuria was 8, 16, 23, 35 and 74 % on day 3, 4, 5, 5 and 7 with the
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567
[ ieU[1320 4 -fiJ
1 98 (jif4fj
l
mHfi 70 )VAf- v t11Ddpoundxr~b Foley
tJ 7- - 7- )VO) wr6~~IiJjIl3tlJml[-gt ~
J1ri~[amp~ffllfNrIrrWttlt (tiE t3J1lWtf(1) ~ ~ ~ ill ~ m _ fTJlt- itamiddot t gtf- Tl e
ACf1HiJiiltl (M~ bull iffiMeA) m If JC rt bull ~ m R j
ZZ=rp9~Jiil~ (MU bull ~t1Jtr~)
~t ~ J in ffiitffHiJiiltl (fllW bull YGE~A)
Rz JlAmiddotkgg BA bull HZ) J~ili
EFFICACY OF A LATEX FOLEY CATHETER WITH
SUSTAINED RELEASE OF CHLORHEXIDINE 1ST REPORT
CLINICAL TRIALS FOR PREVENTION OF URINARY TRACT INFECTION
Hiroshi NAKANO ShOllZOU SEKO
Tooru SU~III and Hiromi NIHIRA
From the Department of Urology llir05hima UniV(f5ity School of Medicine
(Dimtor Prof H Nihria)
Motohiro FUJII and KATSUHlKO OKADA
From the Urological Clinic llir05hima General i105pital
(Chief Dr M Fujii)
Taiji KITAKO
From the Urological Clinic Futami Cmtral i105pital
(Chicj Dr T Aiano)
r-1itsuo KODA~IA Yoshio OHNlsm and Takuya OKUTAJI
From he Urological Clinic OJlomichi Cmeral llo5pial
(Chicj Dr M Kodama)
Seventy five patients requiring urethral catherization for over 21 hours ere treated with
a latex Foley catheter with sustained release of chlorhexidine in a closed drainage system
While the catheter was indwell urinary concentrations of chlorhexidine were maintained
at the level of I to 2flgml in average in almost al patients
The catheter WaS highly effective in preventing the acquisition of catheter-associated bacshy
teriuria in patients with initially sterile urine without systemic antimicrobial therapy The
aquisition rate of bacteriuria was 8 16 23 35 and 74 on day 3 4 5 5 and 7 with the
I 5G8
catheter indwell respeetivel)
The catheter was not elTcetive in eradicating precxisting bacteriuria Cornplieltions of the catheter were minimal
Key words Inling catheter Prevention of urinary trael infection Closed drainage Catheter with sustained release of ehlorhcxidinc
mLt- tgtt (8) -Ctnt- h ~Q)lliljQ) brlmf~lti S marcesctnS ~ Q) I tt~~ ~ (llt~iM~tr~t1i
11lll19=11rr t~~~lriQIJ i t-lt~Q)-yenm~Q)Jffirb-ClRmm mfi1l1tJ1~~n -e~tsHiEjIjlJ IQ) t Q)-C~ Q ~l1~
Q) Utljmiddot ~ li1~ wrr~ttt-~1UIHj70~ ~lIJt- ~Q)IQ)liE1J Wfillit S marasctns Af morgan ii PsrurJOnlomas III It1rnmViHHilamp Xi~P~lli~Q)lJHRi1Jill ~ Q ~ ts cQ) 7 A~Jl1tj1WIJ~ lt 7 Amttfii-Clt S
Table 2 Risk of development of bacteriuria after indwelling catheterization of SR-C catheter in 35 abacteriuric patients without systemic antimicrobill prophylaxis
1) ER 3~ X 100 2 F=B poundD x 100 Abbrevtation used
A Cumulativemiddotllo of patients with indwelling catheterization of SR-C cHh=ter B No of patients ~Iith abacteriuria C No of patients with acquired bacteriuria 0 Cumulative No of patients infected F CU-ulative percent infected
Table 3 Microorganisms isolated from acquired bacteriuria in II patients after indwelling catheterization of SR-C catheter and their MIC against chlorhexidinc dihydrochrolidc
Microorganism MICmiddot 1
016 031 063 125
S marecscens 11 morganH 1 acruginoBa Pseudomonas sp E coli C freundii
S focealis S epidermidis 1
Totol () 1(8) 1(8) -MIC of the firat-isolated otrain of the
I ~Wtjmiddotil Ifj Iht- Wrnjjtr~Rrp7t~~EliH~31 tj~W
fflc bull f~lliMl PJv 4- V~ Itt-t 7gt ~IIC ~
Table 4 lff--t 21f[j)J~Iij J 7gt amp~secti~il
9 OiJ (45) 17 Ittbull f~ b 5 lIHt S faecalis
~illi1U L--C~middot7gttJcmiddot0t-~ S faltais ~~h7gt
mmil 30 ~ kU t- r 7 t ~2il1ftUi-c It Pseudoshy
monas~ bull p-C P aeruginosa n~~ C~(tla
)Igml 25 5 10 25 50 100~
Total( )
2 1
3
I
1 4 2 1
1 1 1
( 30) ( 15) ( 0) ( B) ( B) ( B)
2 2 1
(15) ( 8)
5(38) 4(30) 1(8) 1(8) 13 000) same species of the orgonicmo in a patient
E coli A aniralus K mrumoniae H morganii t~
cmiddot-ct7gt h-I~ ~IIC 7JHt 25pgml 11shy
7~1j-t7gtilbull 7t2itUfipoundj-Clt 5~IOpgml ~
t ~il19tkI 5 tk (3G) ~lht- it 120fItJrp-Cru
1llltf~f)l1iilf+71-C5 t I lIJ c sectpound(j9IitWillJ~
OrJlJilfjtdnt- 27oJ~FiH-17~J~rjIWrnf(~~
[bgta-77gt c WilIJJJru1p1ixraquoL-t- clt5-Ct lUtttl~tiWffi c tJ tiEWJlt1Mt- -ttJibUl IllJvm~p~ ltltiJ-ipoundjffil J 7gtWrJ~mt1lIt17f1tJp 9 Ju (53) -C5 ) (t~ 8 llJiJlltruIllJ~n~ltjIItrLshy
lt IHMlUmU- cnl~lIartlLiif1icf~Jtmil
Jv ~middotmiddotV~ 1M-t7gt ~IIC ~ Table 5 Iff--t
~ltfJ~ E coi S faccalis ~~ I tjltfitfitW3lt
Supplied by The British Library - The worlds knowledge
ter n5t
( 30) ( 15) ( lJ) ( 8) ( 8) ( 8)
( 15) ( 8)
Cloo) Itient
morganii ts gml I lshy
middot10 pgml Q)
G20[lIJrlt11
tf~)btWjl(7)
pljJ[ij~Q)a
Itt -C t itchtcgt11 flCft177ltlI 9 IIJIW1ltplZi L
tQ)llilQp
) ff-i
571
S faecalis 2 8 10 (32) S cpidclliIidic 1 1 ( 3) Candida 1 1 ( 3)
Totnl(r) 5(16) 4(13)16(51) 2(7) 2(7) 1(3) 1(3) 31 (100) I
lIot cono i
Table 5 New microorganisms isolnted from preexisting bacteriuria in lJ patients after indwelling catheterizntion of SR-C cntheter and their MIC against chlorhexidinc dihydrochloride
Microorganism MIe nm1 Total ( r ) 125 25 5 10
P aCrllglnooa 2 1 3 ( 28) C frewidii 2 2 ( 18) E coli 2 ( 9) 11 morganU 1 ( 9) E acrogcnca 1 1 ( 9) S mnrCCGCClS 1 1 ( 9)
S faccalilJ 2 2 (18) Total (r) 3(28) 5(46) 3(28) 11 (IOO) -HIC of the first-isolatod of the same species of the organisms in a patient
ftJlq~2tiJ Lt1iEfYlhJ t 7trL~ Itt t (7)lt ~(7) 063 pgml IJ 5 flampt11 50 pgml ltto t
MQ)R~~-cmm~mlt~~ Wffi~mamp~l~ 4 ~~I1I-C
afTuginosa C freundii t c lpu c Lt f 7 A ~2i11 $J 7 - T Iv (7)11Jilltff Ji]lf-ml -C11~jE(Ytl
ftWIJ~ lth~lO I1llifJiilJtt1-Jgt c f 7 lml1W l)(JZc L-C J 7-7Ivli7i ~liRilll~4~ 71Iv
Q)tJim11~middottn it Candida (7)rrt t~l~ L yen - Birc t0) jJi1J~jiEWc ct -C$Qiflt lt~m
ftJ t h Gmtl UHll L tWPJ(7) p Iv ~ ~ Lt SR-C J7middot-7 Iv lJIYJlJmiddotLtUHgthJgtftOHpound
1Mi ~ ~lIC (7)7(IH1 25 pgml I l - 2 ItUlJlf t (7) t ~~-C 13(JlJlK~1O t --tdgttcgtWillfl(j fj L f 7lo ~Sl1fjWl UrI 3 t (33) 11 IO pgl ( b~ Jgt J 7 - 7 Iv fi)) It 2 fll)T (7)fillifciEG11 (
ml bfLt htQ) r-lIC 7(liliJIilliliilJtt(L ~~Jgt c 90-U 02) t7thtIJ fht l 13amp -C~~(fJi11fiil1rQ)ffilcJltllt IJ C freundii lt ltjii9 L 3 El J)1tl tjEOH1 I O~ ( I ) (7)7lt
t 1iEftlJ F-14 (AK 7J) ltIt I EI1ft(7) P afTugishy t1iE1UtU~fc~-cg-~-C 8 (IlJ (II ) ltt
nasa 25 pgml n 5 R amp(7)U gtlgt 25 pgml tiEl1~ Hshy t ~ Q)l 7 1 Iv ~ -UltIHijEjk-gtlQ)Jl1Jvfjpound~tcc I (KM 1) -Cll1J) 13 Q) P arruginosa 25 pgml It~ ltiiZlO-r htQ)hE~Q)tlOtJ 7 -7 Iv JIli1
IJ 3 R ampl 25 pgml tiEI~ F-4 (K K JJ) lt gtcjilrl tjiE1Hi~G1Jrtlt I yJ tffi itJ 7-7
ItfJJ R Q) M morganii 25 pgml 1Jl S amp1 50 pgl I v tl1ampI lt1iEkIJt t1ipoundOU g mi jiEf7J 0-10 (KObull lJ) lt 111J) IJ Q) S faaalis J 7-7Iv(7)0fIll~L-C J 7-7v (7)tifiAJ
0 co-C- 3 A fl~j)rtlcoWii1JViIt~co1iE(fJCOruJ-C-ltffitJ~ lshy
m~ Hlmx ilco~I1co1itWraquoJCOf~tUmtJ
I I
t
40
0 o-----5~---~~-----1=5-----2O----Jo
Days 01
Fig I In vivo release of chlorhexidine dihydrochloride from the inner surface of SR-C catheter in patient 0-1 (Yll male) 0-0 release rate e- cumulative release
m~ c lJtfiiJilJco~t(f)tl~cofJ~mn~~c t1im~J~itril1JHtfJCOlplusmnADn~fHttJ T - T IvfIAtampn I~ till3ttA-t7gt cltff1iJl1~liCO~HllltsiJ7gt
ii](J~l1~1JL -C~7J ltsc l (J kCO~T~~m
iJmlht~tJtc ~xh7gt
S~CtJT-T~~~~~h~P~~~v~CO
fRp co1tltH-Ilthitftsi1rnr-C-t CO-C- Wqt t~~-C
Itf~ ~h -Cflt I~2 glml (1)aiJlffirt3tc ci 7gt c~ kcoinmtJJiJllCO~V3jjTIl i ~l~ c It~
x Iht~ ~ c n 1 Wniilll--C-IlWJltJ1iI~lt~
1i-t liEOiH COjl T - T Ivcorura~dJlI~-t 7gt t CO~IH~~ L n L fstJ1 SR-C tJ T - T Ivlt in
vitro 1~Ht~~9l nl Jmiddotffi~hf l 5 I in vitO -C-AWmmbt (J-mcotJtwXIJmnt~n~
mLt- tgtt (8) -Ctnt- h ~Q)lliljQ) brlmf~lti S marcesctnS ~ Q) I tt~~ ~ (llt~iM~tr~t1i
11lll19=11rr t~~~lriQIJ i t-lt~Q)-yenm~Q)Jffirb-ClRmm mfi1l1tJ1~~n -e~tsHiEjIjlJ IQ) t Q)-C~ Q ~l1~
Q) Utljmiddot ~ li1~ wrr~ttt-~1UIHj70~ ~lIJt- ~Q)IQ)liE1J Wfillit S marasctns Af morgan ii PsrurJOnlomas III It1rnmViHHilamp Xi~P~lli~Q)lJHRi1Jill ~ Q ~ ts cQ) 7 A~Jl1tj1WIJ~ lt 7 Amttfii-Clt S
Table 2 Risk of development of bacteriuria after indwelling catheterization of SR-C catheter in 35 abacteriuric patients without systemic antimicrobill prophylaxis
1) ER 3~ X 100 2 F=B poundD x 100 Abbrevtation used
A Cumulativemiddotllo of patients with indwelling catheterization of SR-C cHh=ter B No of patients ~Iith abacteriuria C No of patients with acquired bacteriuria 0 Cumulative No of patients infected F CU-ulative percent infected
Table 3 Microorganisms isolated from acquired bacteriuria in II patients after indwelling catheterization of SR-C catheter and their MIC against chlorhexidinc dihydrochrolidc
Microorganism MICmiddot 1
016 031 063 125
S marecscens 11 morganH 1 acruginoBa Pseudomonas sp E coli C freundii
S focealis S epidermidis 1
Totol () 1(8) 1(8) -MIC of the firat-isolated otrain of the
I ~Wtjmiddotil Ifj Iht- Wrnjjtr~Rrp7t~~EliH~31 tj~W
fflc bull f~lliMl PJv 4- V~ Itt-t 7gt ~IIC ~
Table 4 lff--t 21f[j)J~Iij J 7gt amp~secti~il
9 OiJ (45) 17 Ittbull f~ b 5 lIHt S faecalis
~illi1U L--C~middot7gttJcmiddot0t-~ S faltais ~~h7gt
mmil 30 ~ kU t- r 7 t ~2il1ftUi-c It Pseudoshy
monas~ bull p-C P aeruginosa n~~ C~(tla
)Igml 25 5 10 25 50 100~
Total( )
2 1
3
I
1 4 2 1
1 1 1
( 30) ( 15) ( 0) ( B) ( B) ( B)
2 2 1
(15) ( 8)
5(38) 4(30) 1(8) 1(8) 13 000) same species of the orgonicmo in a patient
E coli A aniralus K mrumoniae H morganii t~
cmiddot-ct7gt h-I~ ~IIC 7JHt 25pgml 11shy
7~1j-t7gtilbull 7t2itUfipoundj-Clt 5~IOpgml ~
t ~il19tkI 5 tk (3G) ~lht- it 120fItJrp-Cru
1llltf~f)l1iilf+71-C5 t I lIJ c sectpound(j9IitWillJ~
OrJlJilfjtdnt- 27oJ~FiH-17~J~rjIWrnf(~~
[bgta-77gt c WilIJJJru1p1ixraquoL-t- clt5-Ct lUtttl~tiWffi c tJ tiEWJlt1Mt- -ttJibUl IllJvm~p~ ltltiJ-ipoundjffil J 7gtWrJ~mt1lIt17f1tJp 9 Ju (53) -C5 ) (t~ 8 llJiJlltruIllJ~n~ltjIItrLshy
lt IHMlUmU- cnl~lIartlLiif1icf~Jtmil
Jv ~middotmiddotV~ 1M-t7gt ~IIC ~ Table 5 Iff--t
~ltfJ~ E coi S faccalis ~~ I tjltfitfitW3lt
Supplied by The British Library - The worlds knowledge
ter n5t
( 30) ( 15) ( lJ) ( 8) ( 8) ( 8)
( 15) ( 8)
Cloo) Itient
morganii ts gml I lshy
middot10 pgml Q)
G20[lIJrlt11
tf~)btWjl(7)
pljJ[ij~Q)a
Itt -C t itchtcgt11 flCft177ltlI 9 IIJIW1ltplZi L
tQ)llilQp
) ff-i
571
S faecalis 2 8 10 (32) S cpidclliIidic 1 1 ( 3) Candida 1 1 ( 3)
Totnl(r) 5(16) 4(13)16(51) 2(7) 2(7) 1(3) 1(3) 31 (100) I
lIot cono i
Table 5 New microorganisms isolnted from preexisting bacteriuria in lJ patients after indwelling catheterizntion of SR-C cntheter and their MIC against chlorhexidinc dihydrochloride
Microorganism MIe nm1 Total ( r ) 125 25 5 10
P aCrllglnooa 2 1 3 ( 28) C frewidii 2 2 ( 18) E coli 2 ( 9) 11 morganU 1 ( 9) E acrogcnca 1 1 ( 9) S mnrCCGCClS 1 1 ( 9)
S faccalilJ 2 2 (18) Total (r) 3(28) 5(46) 3(28) 11 (IOO) -HIC of the first-isolatod of the same species of the organisms in a patient
ftJlq~2tiJ Lt1iEfYlhJ t 7trL~ Itt t (7)lt ~(7) 063 pgml IJ 5 flampt11 50 pgml ltto t
MQ)R~~-cmm~mlt~~ Wffi~mamp~l~ 4 ~~I1I-C
afTuginosa C freundii t c lpu c Lt f 7 A ~2i11 $J 7 - T Iv (7)11Jilltff Ji]lf-ml -C11~jE(Ytl
ftWIJ~ lth~lO I1llifJiilJtt1-Jgt c f 7 lml1W l)(JZc L-C J 7-7Ivli7i ~liRilll~4~ 71Iv
Q)tJim11~middottn it Candida (7)rrt t~l~ L yen - Birc t0) jJi1J~jiEWc ct -C$Qiflt lt~m
ftJ t h Gmtl UHll L tWPJ(7) p Iv ~ ~ Lt SR-C J7middot-7 Iv lJIYJlJmiddotLtUHgthJgtftOHpound
1Mi ~ ~lIC (7)7(IH1 25 pgml I l - 2 ItUlJlf t (7) t ~~-C 13(JlJlK~1O t --tdgttcgtWillfl(j fj L f 7lo ~Sl1fjWl UrI 3 t (33) 11 IO pgl ( b~ Jgt J 7 - 7 Iv fi)) It 2 fll)T (7)fillifciEG11 (
ml bfLt htQ) r-lIC 7(liliJIilliliilJtt(L ~~Jgt c 90-U 02) t7thtIJ fht l 13amp -C~~(fJi11fiil1rQ)ffilcJltllt IJ C freundii lt ltjii9 L 3 El J)1tl tjEOH1 I O~ ( I ) (7)7lt
t 1iEftlJ F-14 (AK 7J) ltIt I EI1ft(7) P afTugishy t1iE1UtU~fc~-cg-~-C 8 (IlJ (II ) ltt
nasa 25 pgml n 5 R amp(7)U gtlgt 25 pgml tiEl1~ Hshy t ~ Q)l 7 1 Iv ~ -UltIHijEjk-gtlQ)Jl1Jvfjpound~tcc I (KM 1) -Cll1J) 13 Q) P arruginosa 25 pgml It~ ltiiZlO-r htQ)hE~Q)tlOtJ 7 -7 Iv JIli1
IJ 3 R ampl 25 pgml tiEI~ F-4 (K K JJ) lt gtcjilrl tjiE1Hi~G1Jrtlt I yJ tffi itJ 7-7
ItfJJ R Q) M morganii 25 pgml 1Jl S amp1 50 pgl I v tl1ampI lt1iEkIJt t1ipoundOU g mi jiEf7J 0-10 (KObull lJ) lt 111J) IJ Q) S faaalis J 7-7Iv(7)0fIll~L-C J 7-7v (7)tifiAJ
0 co-C- 3 A fl~j)rtlcoWii1JViIt~co1iE(fJCOruJ-C-ltffitJ~ lshy
m~ Hlmx ilco~I1co1itWraquoJCOf~tUmtJ
I I
t
40
0 o-----5~---~~-----1=5-----2O----Jo
Days 01
Fig I In vivo release of chlorhexidine dihydrochloride from the inner surface of SR-C catheter in patient 0-1 (Yll male) 0-0 release rate e- cumulative release
m~ c lJtfiiJilJco~t(f)tl~cofJ~mn~~c t1im~J~itril1JHtfJCOlplusmnADn~fHttJ T - T IvfIAtampn I~ till3ttA-t7gt cltff1iJl1~liCO~HllltsiJ7gt
ii](J~l1~1JL -C~7J ltsc l (J kCO~T~~m
iJmlht~tJtc ~xh7gt
S~CtJT-T~~~~~h~P~~~v~CO
fRp co1tltH-Ilthitftsi1rnr-C-t CO-C- Wqt t~~-C
Itf~ ~h -Cflt I~2 glml (1)aiJlffirt3tc ci 7gt c~ kcoinmtJJiJllCO~V3jjTIl i ~l~ c It~
x Iht~ ~ c n 1 Wniilll--C-IlWJltJ1iI~lt~
1i-t liEOiH COjl T - T Ivcorura~dJlI~-t 7gt t CO~IH~~ L n L fstJ1 SR-C tJ T - T Ivlt in
vitro 1~Ht~~9l nl Jmiddotffi~hf l 5 I in vitO -C-AWmmbt (J-mcotJtwXIJmnt~n~
mLt- tgtt (8) -Ctnt- h ~Q)lliljQ) brlmf~lti S marcesctnS ~ Q) I tt~~ ~ (llt~iM~tr~t1i
11lll19=11rr t~~~lriQIJ i t-lt~Q)-yenm~Q)Jffirb-ClRmm mfi1l1tJ1~~n -e~tsHiEjIjlJ IQ) t Q)-C~ Q ~l1~
Q) Utljmiddot ~ li1~ wrr~ttt-~1UIHj70~ ~lIJt- ~Q)IQ)liE1J Wfillit S marasctns Af morgan ii PsrurJOnlomas III It1rnmViHHilamp Xi~P~lli~Q)lJHRi1Jill ~ Q ~ ts cQ) 7 A~Jl1tj1WIJ~ lt 7 Amttfii-Clt S
Table 2 Risk of development of bacteriuria after indwelling catheterization of SR-C catheter in 35 abacteriuric patients without systemic antimicrobill prophylaxis
1) ER 3~ X 100 2 F=B poundD x 100 Abbrevtation used
A Cumulativemiddotllo of patients with indwelling catheterization of SR-C cHh=ter B No of patients ~Iith abacteriuria C No of patients with acquired bacteriuria 0 Cumulative No of patients infected F CU-ulative percent infected
Table 3 Microorganisms isolated from acquired bacteriuria in II patients after indwelling catheterization of SR-C catheter and their MIC against chlorhexidinc dihydrochrolidc
Microorganism MICmiddot 1
016 031 063 125
S marecscens 11 morganH 1 acruginoBa Pseudomonas sp E coli C freundii
S focealis S epidermidis 1
Totol () 1(8) 1(8) -MIC of the firat-isolated otrain of the
I ~Wtjmiddotil Ifj Iht- Wrnjjtr~Rrp7t~~EliH~31 tj~W
fflc bull f~lliMl PJv 4- V~ Itt-t 7gt ~IIC ~
Table 4 lff--t 21f[j)J~Iij J 7gt amp~secti~il
9 OiJ (45) 17 Ittbull f~ b 5 lIHt S faecalis
~illi1U L--C~middot7gttJcmiddot0t-~ S faltais ~~h7gt
mmil 30 ~ kU t- r 7 t ~2il1ftUi-c It Pseudoshy
monas~ bull p-C P aeruginosa n~~ C~(tla
)Igml 25 5 10 25 50 100~
Total( )
2 1
3
I
1 4 2 1
1 1 1
( 30) ( 15) ( 0) ( B) ( B) ( B)
2 2 1
(15) ( 8)
5(38) 4(30) 1(8) 1(8) 13 000) same species of the orgonicmo in a patient
E coli A aniralus K mrumoniae H morganii t~
cmiddot-ct7gt h-I~ ~IIC 7JHt 25pgml 11shy
7~1j-t7gtilbull 7t2itUfipoundj-Clt 5~IOpgml ~
t ~il19tkI 5 tk (3G) ~lht- it 120fItJrp-Cru
1llltf~f)l1iilf+71-C5 t I lIJ c sectpound(j9IitWillJ~
OrJlJilfjtdnt- 27oJ~FiH-17~J~rjIWrnf(~~
[bgta-77gt c WilIJJJru1p1ixraquoL-t- clt5-Ct lUtttl~tiWffi c tJ tiEWJlt1Mt- -ttJibUl IllJvm~p~ ltltiJ-ipoundjffil J 7gtWrJ~mt1lIt17f1tJp 9 Ju (53) -C5 ) (t~ 8 llJiJlltruIllJ~n~ltjIItrLshy
lt IHMlUmU- cnl~lIartlLiif1icf~Jtmil
Jv ~middotmiddotV~ 1M-t7gt ~IIC ~ Table 5 Iff--t
~ltfJ~ E coi S faccalis ~~ I tjltfitfitW3lt
Supplied by The British Library - The worlds knowledge
ter n5t
( 30) ( 15) ( lJ) ( 8) ( 8) ( 8)
( 15) ( 8)
Cloo) Itient
morganii ts gml I lshy
middot10 pgml Q)
G20[lIJrlt11
tf~)btWjl(7)
pljJ[ij~Q)a
Itt -C t itchtcgt11 flCft177ltlI 9 IIJIW1ltplZi L
tQ)llilQp
) ff-i
571
S faecalis 2 8 10 (32) S cpidclliIidic 1 1 ( 3) Candida 1 1 ( 3)
Totnl(r) 5(16) 4(13)16(51) 2(7) 2(7) 1(3) 1(3) 31 (100) I
lIot cono i
Table 5 New microorganisms isolnted from preexisting bacteriuria in lJ patients after indwelling catheterizntion of SR-C cntheter and their MIC against chlorhexidinc dihydrochloride
Microorganism MIe nm1 Total ( r ) 125 25 5 10
P aCrllglnooa 2 1 3 ( 28) C frewidii 2 2 ( 18) E coli 2 ( 9) 11 morganU 1 ( 9) E acrogcnca 1 1 ( 9) S mnrCCGCClS 1 1 ( 9)
S faccalilJ 2 2 (18) Total (r) 3(28) 5(46) 3(28) 11 (IOO) -HIC of the first-isolatod of the same species of the organisms in a patient
ftJlq~2tiJ Lt1iEfYlhJ t 7trL~ Itt t (7)lt ~(7) 063 pgml IJ 5 flampt11 50 pgml ltto t
MQ)R~~-cmm~mlt~~ Wffi~mamp~l~ 4 ~~I1I-C
afTuginosa C freundii t c lpu c Lt f 7 A ~2i11 $J 7 - T Iv (7)11Jilltff Ji]lf-ml -C11~jE(Ytl
ftWIJ~ lth~lO I1llifJiilJtt1-Jgt c f 7 lml1W l)(JZc L-C J 7-7Ivli7i ~liRilll~4~ 71Iv
Q)tJim11~middottn it Candida (7)rrt t~l~ L yen - Birc t0) jJi1J~jiEWc ct -C$Qiflt lt~m
ftJ t h Gmtl UHll L tWPJ(7) p Iv ~ ~ Lt SR-C J7middot-7 Iv lJIYJlJmiddotLtUHgthJgtftOHpound
1Mi ~ ~lIC (7)7(IH1 25 pgml I l - 2 ItUlJlf t (7) t ~~-C 13(JlJlK~1O t --tdgttcgtWillfl(j fj L f 7lo ~Sl1fjWl UrI 3 t (33) 11 IO pgl ( b~ Jgt J 7 - 7 Iv fi)) It 2 fll)T (7)fillifciEG11 (
ml bfLt htQ) r-lIC 7(liliJIilliliilJtt(L ~~Jgt c 90-U 02) t7thtIJ fht l 13amp -C~~(fJi11fiil1rQ)ffilcJltllt IJ C freundii lt ltjii9 L 3 El J)1tl tjEOH1 I O~ ( I ) (7)7lt
t 1iEftlJ F-14 (AK 7J) ltIt I EI1ft(7) P afTugishy t1iE1UtU~fc~-cg-~-C 8 (IlJ (II ) ltt
nasa 25 pgml n 5 R amp(7)U gtlgt 25 pgml tiEl1~ Hshy t ~ Q)l 7 1 Iv ~ -UltIHijEjk-gtlQ)Jl1Jvfjpound~tcc I (KM 1) -Cll1J) 13 Q) P arruginosa 25 pgml It~ ltiiZlO-r htQ)hE~Q)tlOtJ 7 -7 Iv JIli1
IJ 3 R ampl 25 pgml tiEI~ F-4 (K K JJ) lt gtcjilrl tjiE1Hi~G1Jrtlt I yJ tffi itJ 7-7
ItfJJ R Q) M morganii 25 pgml 1Jl S amp1 50 pgl I v tl1ampI lt1iEkIJt t1ipoundOU g mi jiEf7J 0-10 (KObull lJ) lt 111J) IJ Q) S faaalis J 7-7Iv(7)0fIll~L-C J 7-7v (7)tifiAJ
0 co-C- 3 A fl~j)rtlcoWii1JViIt~co1iE(fJCOruJ-C-ltffitJ~ lshy
m~ Hlmx ilco~I1co1itWraquoJCOf~tUmtJ
I I
t
40
0 o-----5~---~~-----1=5-----2O----Jo
Days 01
Fig I In vivo release of chlorhexidine dihydrochloride from the inner surface of SR-C catheter in patient 0-1 (Yll male) 0-0 release rate e- cumulative release
m~ c lJtfiiJilJco~t(f)tl~cofJ~mn~~c t1im~J~itril1JHtfJCOlplusmnADn~fHttJ T - T IvfIAtampn I~ till3ttA-t7gt cltff1iJl1~liCO~HllltsiJ7gt
ii](J~l1~1JL -C~7J ltsc l (J kCO~T~~m
iJmlht~tJtc ~xh7gt
S~CtJT-T~~~~~h~P~~~v~CO
fRp co1tltH-Ilthitftsi1rnr-C-t CO-C- Wqt t~~-C
Itf~ ~h -Cflt I~2 glml (1)aiJlffirt3tc ci 7gt c~ kcoinmtJJiJllCO~V3jjTIl i ~l~ c It~
x Iht~ ~ c n 1 Wniilll--C-IlWJltJ1iI~lt~
1i-t liEOiH COjl T - T Ivcorura~dJlI~-t 7gt t CO~IH~~ L n L fstJ1 SR-C tJ T - T Ivlt in
vitro 1~Ht~~9l nl Jmiddotffi~hf l 5 I in vitO -C-AWmmbt (J-mcotJtwXIJmnt~n~
Table 2 Risk of development of bacteriuria after indwelling catheterization of SR-C catheter in 35 abacteriuric patients without systemic antimicrobill prophylaxis
1) ER 3~ X 100 2 F=B poundD x 100 Abbrevtation used
A Cumulativemiddotllo of patients with indwelling catheterization of SR-C cHh=ter B No of patients ~Iith abacteriuria C No of patients with acquired bacteriuria 0 Cumulative No of patients infected F CU-ulative percent infected
Table 3 Microorganisms isolated from acquired bacteriuria in II patients after indwelling catheterization of SR-C catheter and their MIC against chlorhexidinc dihydrochrolidc
Microorganism MICmiddot 1
016 031 063 125
S marecscens 11 morganH 1 acruginoBa Pseudomonas sp E coli C freundii
S focealis S epidermidis 1
Totol () 1(8) 1(8) -MIC of the firat-isolated otrain of the
I ~Wtjmiddotil Ifj Iht- Wrnjjtr~Rrp7t~~EliH~31 tj~W
fflc bull f~lliMl PJv 4- V~ Itt-t 7gt ~IIC ~
Table 4 lff--t 21f[j)J~Iij J 7gt amp~secti~il
9 OiJ (45) 17 Ittbull f~ b 5 lIHt S faecalis
~illi1U L--C~middot7gttJcmiddot0t-~ S faltais ~~h7gt
mmil 30 ~ kU t- r 7 t ~2il1ftUi-c It Pseudoshy
monas~ bull p-C P aeruginosa n~~ C~(tla
)Igml 25 5 10 25 50 100~
Total( )
2 1
3
I
1 4 2 1
1 1 1
( 30) ( 15) ( 0) ( B) ( B) ( B)
2 2 1
(15) ( 8)
5(38) 4(30) 1(8) 1(8) 13 000) same species of the orgonicmo in a patient
E coli A aniralus K mrumoniae H morganii t~
cmiddot-ct7gt h-I~ ~IIC 7JHt 25pgml 11shy
7~1j-t7gtilbull 7t2itUfipoundj-Clt 5~IOpgml ~
t ~il19tkI 5 tk (3G) ~lht- it 120fItJrp-Cru
1llltf~f)l1iilf+71-C5 t I lIJ c sectpound(j9IitWillJ~
OrJlJilfjtdnt- 27oJ~FiH-17~J~rjIWrnf(~~
[bgta-77gt c WilIJJJru1p1ixraquoL-t- clt5-Ct lUtttl~tiWffi c tJ tiEWJlt1Mt- -ttJibUl IllJvm~p~ ltltiJ-ipoundjffil J 7gtWrJ~mt1lIt17f1tJp 9 Ju (53) -C5 ) (t~ 8 llJiJlltruIllJ~n~ltjIItrLshy
lt IHMlUmU- cnl~lIartlLiif1icf~Jtmil
Jv ~middotmiddotV~ 1M-t7gt ~IIC ~ Table 5 Iff--t
~ltfJ~ E coi S faccalis ~~ I tjltfitfitW3lt
Supplied by The British Library - The worlds knowledge
ter n5t
( 30) ( 15) ( lJ) ( 8) ( 8) ( 8)
( 15) ( 8)
Cloo) Itient
morganii ts gml I lshy
middot10 pgml Q)
G20[lIJrlt11
tf~)btWjl(7)
pljJ[ij~Q)a
Itt -C t itchtcgt11 flCft177ltlI 9 IIJIW1ltplZi L
tQ)llilQp
) ff-i
571
S faecalis 2 8 10 (32) S cpidclliIidic 1 1 ( 3) Candida 1 1 ( 3)
Totnl(r) 5(16) 4(13)16(51) 2(7) 2(7) 1(3) 1(3) 31 (100) I
lIot cono i
Table 5 New microorganisms isolnted from preexisting bacteriuria in lJ patients after indwelling catheterizntion of SR-C cntheter and their MIC against chlorhexidinc dihydrochloride
Microorganism MIe nm1 Total ( r ) 125 25 5 10
P aCrllglnooa 2 1 3 ( 28) C frewidii 2 2 ( 18) E coli 2 ( 9) 11 morganU 1 ( 9) E acrogcnca 1 1 ( 9) S mnrCCGCClS 1 1 ( 9)
S faccalilJ 2 2 (18) Total (r) 3(28) 5(46) 3(28) 11 (IOO) -HIC of the first-isolatod of the same species of the organisms in a patient
ftJlq~2tiJ Lt1iEfYlhJ t 7trL~ Itt t (7)lt ~(7) 063 pgml IJ 5 flampt11 50 pgml ltto t
MQ)R~~-cmm~mlt~~ Wffi~mamp~l~ 4 ~~I1I-C
afTuginosa C freundii t c lpu c Lt f 7 A ~2i11 $J 7 - T Iv (7)11Jilltff Ji]lf-ml -C11~jE(Ytl
ftWIJ~ lth~lO I1llifJiilJtt1-Jgt c f 7 lml1W l)(JZc L-C J 7-7Ivli7i ~liRilll~4~ 71Iv
Q)tJim11~middottn it Candida (7)rrt t~l~ L yen - Birc t0) jJi1J~jiEWc ct -C$Qiflt lt~m
ftJ t h Gmtl UHll L tWPJ(7) p Iv ~ ~ Lt SR-C J7middot-7 Iv lJIYJlJmiddotLtUHgthJgtftOHpound
1Mi ~ ~lIC (7)7(IH1 25 pgml I l - 2 ItUlJlf t (7) t ~~-C 13(JlJlK~1O t --tdgttcgtWillfl(j fj L f 7lo ~Sl1fjWl UrI 3 t (33) 11 IO pgl ( b~ Jgt J 7 - 7 Iv fi)) It 2 fll)T (7)fillifciEG11 (
ml bfLt htQ) r-lIC 7(liliJIilliliilJtt(L ~~Jgt c 90-U 02) t7thtIJ fht l 13amp -C~~(fJi11fiil1rQ)ffilcJltllt IJ C freundii lt ltjii9 L 3 El J)1tl tjEOH1 I O~ ( I ) (7)7lt
t 1iEftlJ F-14 (AK 7J) ltIt I EI1ft(7) P afTugishy t1iE1UtU~fc~-cg-~-C 8 (IlJ (II ) ltt
nasa 25 pgml n 5 R amp(7)U gtlgt 25 pgml tiEl1~ Hshy t ~ Q)l 7 1 Iv ~ -UltIHijEjk-gtlQ)Jl1Jvfjpound~tcc I (KM 1) -Cll1J) 13 Q) P arruginosa 25 pgml It~ ltiiZlO-r htQ)hE~Q)tlOtJ 7 -7 Iv JIli1
IJ 3 R ampl 25 pgml tiEI~ F-4 (K K JJ) lt gtcjilrl tjiE1Hi~G1Jrtlt I yJ tffi itJ 7-7
ItfJJ R Q) M morganii 25 pgml 1Jl S amp1 50 pgl I v tl1ampI lt1iEkIJt t1ipoundOU g mi jiEf7J 0-10 (KObull lJ) lt 111J) IJ Q) S faaalis J 7-7Iv(7)0fIll~L-C J 7-7v (7)tifiAJ
0 co-C- 3 A fl~j)rtlcoWii1JViIt~co1iE(fJCOruJ-C-ltffitJ~ lshy
m~ Hlmx ilco~I1co1itWraquoJCOf~tUmtJ
I I
t
40
0 o-----5~---~~-----1=5-----2O----Jo
Days 01
Fig I In vivo release of chlorhexidine dihydrochloride from the inner surface of SR-C catheter in patient 0-1 (Yll male) 0-0 release rate e- cumulative release
m~ c lJtfiiJilJco~t(f)tl~cofJ~mn~~c t1im~J~itril1JHtfJCOlplusmnADn~fHttJ T - T IvfIAtampn I~ till3ttA-t7gt cltff1iJl1~liCO~HllltsiJ7gt
ii](J~l1~1JL -C~7J ltsc l (J kCO~T~~m
iJmlht~tJtc ~xh7gt
S~CtJT-T~~~~~h~P~~~v~CO
fRp co1tltH-Ilthitftsi1rnr-C-t CO-C- Wqt t~~-C
Itf~ ~h -Cflt I~2 glml (1)aiJlffirt3tc ci 7gt c~ kcoinmtJJiJllCO~V3jjTIl i ~l~ c It~
x Iht~ ~ c n 1 Wniilll--C-IlWJltJ1iI~lt~
1i-t liEOiH COjl T - T Ivcorura~dJlI~-t 7gt t CO~IH~~ L n L fstJ1 SR-C tJ T - T Ivlt in
vitro 1~Ht~~9l nl Jmiddotffi~hf l 5 I in vitO -C-AWmmbt (J-mcotJtwXIJmnt~n~
S faecalis 2 8 10 (32) S cpidclliIidic 1 1 ( 3) Candida 1 1 ( 3)
Totnl(r) 5(16) 4(13)16(51) 2(7) 2(7) 1(3) 1(3) 31 (100) I
lIot cono i
Table 5 New microorganisms isolnted from preexisting bacteriuria in lJ patients after indwelling catheterizntion of SR-C cntheter and their MIC against chlorhexidinc dihydrochloride
Microorganism MIe nm1 Total ( r ) 125 25 5 10
P aCrllglnooa 2 1 3 ( 28) C frewidii 2 2 ( 18) E coli 2 ( 9) 11 morganU 1 ( 9) E acrogcnca 1 1 ( 9) S mnrCCGCClS 1 1 ( 9)
S faccalilJ 2 2 (18) Total (r) 3(28) 5(46) 3(28) 11 (IOO) -HIC of the first-isolatod of the same species of the organisms in a patient
ftJlq~2tiJ Lt1iEfYlhJ t 7trL~ Itt t (7)lt ~(7) 063 pgml IJ 5 flampt11 50 pgml ltto t
MQ)R~~-cmm~mlt~~ Wffi~mamp~l~ 4 ~~I1I-C
afTuginosa C freundii t c lpu c Lt f 7 A ~2i11 $J 7 - T Iv (7)11Jilltff Ji]lf-ml -C11~jE(Ytl
ftWIJ~ lth~lO I1llifJiilJtt1-Jgt c f 7 lml1W l)(JZc L-C J 7-7Ivli7i ~liRilll~4~ 71Iv
Q)tJim11~middottn it Candida (7)rrt t~l~ L yen - Birc t0) jJi1J~jiEWc ct -C$Qiflt lt~m
ftJ t h Gmtl UHll L tWPJ(7) p Iv ~ ~ Lt SR-C J7middot-7 Iv lJIYJlJmiddotLtUHgthJgtftOHpound
1Mi ~ ~lIC (7)7(IH1 25 pgml I l - 2 ItUlJlf t (7) t ~~-C 13(JlJlK~1O t --tdgttcgtWillfl(j fj L f 7lo ~Sl1fjWl UrI 3 t (33) 11 IO pgl ( b~ Jgt J 7 - 7 Iv fi)) It 2 fll)T (7)fillifciEG11 (
ml bfLt htQ) r-lIC 7(liliJIilliliilJtt(L ~~Jgt c 90-U 02) t7thtIJ fht l 13amp -C~~(fJi11fiil1rQ)ffilcJltllt IJ C freundii lt ltjii9 L 3 El J)1tl tjEOH1 I O~ ( I ) (7)7lt
t 1iEftlJ F-14 (AK 7J) ltIt I EI1ft(7) P afTugishy t1iE1UtU~fc~-cg-~-C 8 (IlJ (II ) ltt
nasa 25 pgml n 5 R amp(7)U gtlgt 25 pgml tiEl1~ Hshy t ~ Q)l 7 1 Iv ~ -UltIHijEjk-gtlQ)Jl1Jvfjpound~tcc I (KM 1) -Cll1J) 13 Q) P arruginosa 25 pgml It~ ltiiZlO-r htQ)hE~Q)tlOtJ 7 -7 Iv JIli1
IJ 3 R ampl 25 pgml tiEI~ F-4 (K K JJ) lt gtcjilrl tjiE1Hi~G1Jrtlt I yJ tffi itJ 7-7
ItfJJ R Q) M morganii 25 pgml 1Jl S amp1 50 pgl I v tl1ampI lt1iEkIJt t1ipoundOU g mi jiEf7J 0-10 (KObull lJ) lt 111J) IJ Q) S faaalis J 7-7Iv(7)0fIll~L-C J 7-7v (7)tifiAJ
0 co-C- 3 A fl~j)rtlcoWii1JViIt~co1iE(fJCOruJ-C-ltffitJ~ lshy
m~ Hlmx ilco~I1co1itWraquoJCOf~tUmtJ
I I
t
40
0 o-----5~---~~-----1=5-----2O----Jo
Days 01
Fig I In vivo release of chlorhexidine dihydrochloride from the inner surface of SR-C catheter in patient 0-1 (Yll male) 0-0 release rate e- cumulative release
m~ c lJtfiiJilJco~t(f)tl~cofJ~mn~~c t1im~J~itril1JHtfJCOlplusmnADn~fHttJ T - T IvfIAtampn I~ till3ttA-t7gt cltff1iJl1~liCO~HllltsiJ7gt
ii](J~l1~1JL -C~7J ltsc l (J kCO~T~~m
iJmlht~tJtc ~xh7gt
S~CtJT-T~~~~~h~P~~~v~CO
fRp co1tltH-Ilthitftsi1rnr-C-t CO-C- Wqt t~~-C
Itf~ ~h -Cflt I~2 glml (1)aiJlffirt3tc ci 7gt c~ kcoinmtJJiJllCO~V3jjTIl i ~l~ c It~
x Iht~ ~ c n 1 Wniilll--C-IlWJltJ1iI~lt~
1i-t liEOiH COjl T - T Ivcorura~dJlI~-t 7gt t CO~IH~~ L n L fstJ1 SR-C tJ T - T Ivlt in
vitro 1~Ht~~9l nl Jmiddotffi~hf l 5 I in vitO -C-AWmmbt (J-mcotJtwXIJmnt~n~
0 co-C- 3 A fl~j)rtlcoWii1JViIt~co1iE(fJCOruJ-C-ltffitJ~ lshy
m~ Hlmx ilco~I1co1itWraquoJCOf~tUmtJ
I I
t
40
0 o-----5~---~~-----1=5-----2O----Jo
Days 01
Fig I In vivo release of chlorhexidine dihydrochloride from the inner surface of SR-C catheter in patient 0-1 (Yll male) 0-0 release rate e- cumulative release
m~ c lJtfiiJilJco~t(f)tl~cofJ~mn~~c t1im~J~itril1JHtfJCOlplusmnADn~fHttJ T - T IvfIAtampn I~ till3ttA-t7gt cltff1iJl1~liCO~HllltsiJ7gt
ii](J~l1~1JL -C~7J ltsc l (J kCO~T~~m
iJmlht~tJtc ~xh7gt
S~CtJT-T~~~~~h~P~~~v~CO
fRp co1tltH-Ilthitftsi1rnr-C-t CO-C- Wqt t~~-C
Itf~ ~h -Cflt I~2 glml (1)aiJlffirt3tc ci 7gt c~ kcoinmtJJiJllCO~V3jjTIl i ~l~ c It~
x Iht~ ~ c n 1 Wniilll--C-IlWJltJ1iI~lt~
1i-t liEOiH COjl T - T Ivcorura~dJlI~-t 7gt t CO~IH~~ L n L fstJ1 SR-C tJ T - T Ivlt in
vitro 1~Ht~~9l nl Jmiddotffi~hf l 5 I in vitO -C-AWmmbt (J-mcotJtwXIJmnt~n~