Prospective Multicenter Multinational Cohort Study: Time-to-central line-associated bloodstream infection with Plain vs Chlorhexidine/Silver Sulfadiazine Impregnated Central Venous Catheters

Background Central line-associated bloodstream infections (CLABSIs) cause preventable harm. We evaluated whether Chlorhexidine/Silver Sulfadiazine (CH/SSD)-impregnated CVCs reduce the CLABSI hazard compared with plain CVCs using time-to-event methodology. Methods A prospective cohort study was conducted in 6 hospitals in India, Malaysia, Papua New Guinea, and Turkey from 03/01/2023-10/31/2025. We included 1,294 plain-CVC patients and 456 CH/SSD-CVC patients. The primary endpoint was time to first CLABSI, estimated by Kaplan-Meier modeled with Cox proportional hazards regression. A prespecified landmark analysis assessed early risk at days 0–5. Results Within 30 days, 51 CLABSIs occurred in the plain-CVC group and 12 in the CH/SSD group. Kaplan–Meier cumulative incidence at 30 CVC-days showed statistically significant separation (log-rank X 2 = 5.309; p=0.021). In the primary Cox proportional hazards model, CH/SSD-CVCs were associated with a significantly lower hazard of CLABSI than plain-CVCs (hazard ratio=0.297; 95%CI= 0.134-0.658; p=0.003). In the prespecified early 0–5-day period, 13 CLABSIs occurred in the plain-CVC group and 0 in the CH/SSD-CVC group (log-rank X 2 =4.923; p=0.026). ICU mortality was higher in the plain-CVC group (28.3% vs. 18.4%; p<0.001). Conclusions CH/SSD-CVCs were associated with a significant reduction in the CLABSI hazard, supporting further study of their use as tools to prevent CLABSI.