Analysis Of The Incidence And Risk Factors Of Intravascular Catheter-related Infections For Burn Patients

Background: Burn can damage the skin barrier,so the wound became the main portal of bacterial invasion,at the same time,body fluid oozing from the wound lead to imbalance of the electrolyte and disorders of the nutritional.Therefore,anti-shock,anti-infection and infusion are required timely for burn patients.Peripheral venous for infusion is not much to large area burn patients,and peripheral intravenous infusion often can not meet the requirement of the body of burn patients.The central venous catheterization can quickly provide a large number of various liquids,stabilize internal environment of body,reduce hemorrhagic shock and be convenient for medical procedures.So central venous become the main channel for infusion in the many advantages.As the use of intravascular catheters increasing gradually,the catheter-related infection(CRI)is a growing incidence,and the most serious is catheter-related bloodstream infections(CRBSI).Infection is a major cause of death in burn patients,CRI and catheter sepsis prolong hospital stay of patient,increase healthcare burden and ultimately affect the prognosis and quality of life of patients.Therefore,exploring the incidence and risk factors of intravascular catheter-related infections is important for clinical practice.Objective: We discussed the incidence,pathogen features and risk factors of intravascular catheter-related infections(CRI),furtherly analyzed its independent risk factors and preventive measures for burn patients by clinical retrospective review,in order to guide clinical practice.Materials and Methods: Cases data for burn patients of intravascular catheter were admitted from June 2011 to June 2015 in burns Institute of Southwest Hospital,Third Military Medical University.General information were consulted,including gender,age,total burn surface area,area of third degree burn injury,cause of injury,severity of inhalation injury,length of hospitalization,prognosis,and all cases catheters on catheterization site,catheterization through wound or not,catheterization time,cultures(specimens including blood,catheter tip,catheter blood),etc.Research consists of four parts: The first part was the statistic to the incidence of intravascular catheter-related infection,and compared the different types of catheters and catheterization site to the incidence of CRI and CRBSI after intravascular catheterization in patient.The second part was the statistic to the pathogen features of intravascular catheter-related infection,and compared CRI pathogens constituent ratio each year,multidrug-resistant pathogen detection rate of pathogens,and the main pathogen of different types of catheters and catheterization site.The third part was screening the risk factors of intravascular catheter-related infections according to general information.The fourth part would be screened statistically significant risk factors for CRI,re-analysis to determine the independent risk factors for CRI by multivariate Logistic regression,and compared CRI incidence after all cases catheterization of the different catheterization time of different catheter types in patient;in the cases of catheterization through wound,further to compare CRI incidence after all cases catheterization of the different catheterization time in patient.Results:(1)The incidence of intravascular catheter-related infection: there were 289 cases met the inclusion criteria,a total of 689 cases of intravascular catheterization,and utilization rate of intravascular catheter was 10.64%(9034/84881);the incidence of CRI was 46.59%(321/689),the infection rate was 35.53 per thousand days(321/9034),and the mortality was 4.84%(14/289).In the cases of CRI,CRBSI occurred 110 cases,accounting for 34.27% of CRI(110/321),the infection rate was 12.18 per thousand days(110/9034),and the mortality was 2.08%(6/289).(2)The incidence of CRI and CRBSI in patient to different types of catheters: CRI incidence after PICC and AC all case catheterization were significantly lower than CVC(with ?2 values 4.424 and 6.820,P <0.05 or <0.01),CRBSI incidence after PICC all case catheterization was significantly lower than CVC(?2 =7.002,P<0.01).(3)The incidence of CRI and CRBSI in patient to different catheterization site: CRI incidence after basilic vein and femoral artery all case catheterization were significantly lower than femoral vein(with ?2 values 5.038 and 7.600,P <0.05 or <0.01),CRBSI incidence after basilic vein all case catheterization were significantly lower than femoral vein(?2 =8.005,P<0.01).CRBSI incidence after the right jugular vein all case catheterization were significantly lower than the left jugular vein(?2 =4.027,P<0.01).CRI and CRBSI incidence after left and right of femoral vein and subclavian vein all case catheterization were no statistically significant differences(P>0.05).(4)The pathogen features of intravascular catheter-related infection: 399 pathogens were detected in CRI cases,Gram negative bacteria was accounting for 68.92%(275/399);Gram-positive bacteria was accounting for 22.31%(89/399);fungi was accounting for 8.77%(35/399).Among them,a total of 149 pathogens were detected in CRBSI cases,Gram-negative bacteria was accounting for 80.54%(120/149),Gram-positive bacteria was accounting for 10.07%(15/149),fungi was accounting for 9.39%(14/149).In CRI and CRBSI pathogens,ranking among the top five pathogens were sequentially Acinetobacter baumannii,Pseudomonas aeruginosa,Staphylococcus aureus,Klebsiella pneumonia,Enterobacter cloacae.(5)CRI pathogens constituent ratio each year: from June 2012 to May 2013,166 were detected,increasing significantly to compare with the other three periods.Acinetobacter baumannii and Enterobacter cloacae increased most obviously.Gram-negative bacteria detection rate showed a declining trend,while Gram-positive bacteria and fungal detection rate showed an increasing trend.(6)Multidrug-resistant pathogen detection rate of pathogens: multi-drug resistant strains of pathogens in CRI is 105,the detection rate was 26.32%(105/399).Among them,the pan-resistant and multi-drug resistant Acinetobacter baumannii(MDR/PDRAB)42 strains,multi-drug resistant and PDRPA(MDR/PDRPA)19 strains,multidrug-resistant Staphylococcus aureus 16 strains,methicillin-resistant Staphylococcus aureus(MRSA)21 strains,multi-drug resistant Klebsiella pneumonia 1 strains,multiple drug-resistant Enterobacter cloacae 4 strains,the detection rates respectively were 32.31%(42/130),22.35%(19/85),22.54%(16/71),29.58%(21/71),5.26%(1 / 19),30.77%(4/13).There were 42 multi-drug resistant strains of pathogens in CRBSI,the detection rate was 28.19%(42/149);Among them,MDR / PDRAB 19 strain,MDR / PDRPA 11 strains,MRSA 8 strains,multi-drug resistant Klebsiella pneumoniae 1 strains and multi-drug resistant Enterobacter cloacae 3 strains,the detection rates respectively were 29.69%(19/64),39.29%(11/28),53.33%(8/15),12.5%(1/8),42.86%(3/7).(7)The main pathogen of different types of catheters and catheterization site: the CRI pathogen of three different types of catheters compared as follows: 19 cases occurred CRI in PICC,the detection of pathogens was accounting for 5.01%(20/399),the top three bacteria were sequentially Staphylococcus aureus 8 strains,Pseudomonas aeruginosa 4 strains,Staphylococcus epidermidis 2 strains.21 cases occurred CRI in AC,the detection of pathogens was accounting for 6.52%(20/399),the detection of multi-drug resistant Staphylococcus aureus 3 strains,Pseudomonas aeruginosa 3 strains;21 cases of CRI occurred in AC,the detection of pathogens was accounted for 6.52%(26/399),the top three bacteria were sequentially Acinetobacter baumannii 10 strains,Pseudomonas aeruginosa 6 strains,Staphylococcus aureus 3 strains;281 cases occurred CRI in CVC,the detection of pathogens was accounting for 88.47%(353/399),the top three bacteria were sequentially Acinetobacter baumannii 119 strains,Pseudomonas aeruginosa 75 strains,Staphylococcus aureus 60 strains.The top three bacteria of basilic vein were sequentially Staphylococcus aureus,Pseudomonas aeruginosa and Staphylococcus epidermidis;the top three bacteria of femoral artery,subclavian vein and femoral vein were sequentially Acinetobacter baumannii,Pseudomonas aeruginosa,Staphylococcus aureus;jugular vein of the top three bacteria were sequentially Staphylococcus aureus,Acinetobacter baumannii,Pseudomonas aeruginosa.(8)The risk factors of intravascular catheter-related infections: there were no statistically significant differences in CRI incidence after catheterization in patient with different gender,age,cause of injury,severity of inhalation injury(with ?2 values from 0.070 to 3.352,P values above 0.05).There were statistically significant differences in CRI incidence after catheterization in patient with different total burn surface area,area of third degree burn injury,catheterization site,catheterization time,catheterization through wound or not(with ?2 values from 13.121 to 27.082,P values below 0.01).(9)Independent risk factors: total burn surface area,catheterization site,catheterization through wound or not and catheterization time(> 7 d)were the independent risk factors of CRI(with odds ratio respectively 1.654,1.218,1.637,2.139,95% confidence interval respectively 1.294-2.114,1.124-2.092,1.136-2.359,1.524-3.002,P values below 0.01).(10)The CRI incidence to the different catheterization time of different catheter types: in the cases of AC catheterization,CRI incidence in patient who receive catheterization less than 7 days was significantly lower than more than or equal to 7 days and less than 14 days(?2 =5.349,P<0.05).In the cases of CVC catheterization,patients shared similar CRI incidence between catheterization time of less than or equal to 3 days,more than 3 days and less than or equal to 5 days(?2=0.001,P>0.05).CRI incidence in patient who receive catheterization the last three periods was higher than more than 3 days and less than or equal to 5 days(with ?2 values from 9.808 to 19.410,P values below 0.01),CRI incidence in patient who receive catheterization less than or equal to 3 days was significantly lower than more than 7 days and less than or equal to 14 days,more than 14 days(with ?2 values 5.799 and 7.519,P<0.05 or P<0.01).(11)The CRI incidence to the different catheterization time of catheterization through wound: in the 164 cases of CVC catheterization through wound,patients shared similar CRI incidence between catheterization time of less than or equal to 4 days,more than 14 days and less than or equal to 6 days(?2 =0.006,P>0.05).CRI incidence in patient who receive catheterization the last two periods was higher than the two periods(with ?2 values from 4.784 to 11.481,P values below 0.05).Conclusion: 1.When burn patients require invascular catheterzation,it is recommended PICC catheterization by basilic vein and artery catheterization by femoral artery.When require jugular vein catheterization,it is recommended by the right jugular vein.2.In CRI and CRBSI pathogens,ranking among the top three pathogens are Acinetobacter baumannii,Pseudomonas aeruginosa,Staphylococcus aureus.CRBSI pathogens are higher multidrug-resistant pathogen detection rate than CRI pathogens.3.Total burn surface area,catheterization site,catheterization through wound or not and catheterization time(>7 d)are the independent risk factors of CRI.4.Arterial catheter is suggested to be removed in 6 days,and central venous catheter is suggested to be removed in 5 days;if catheterization through wounds is not avoidable,removal of central venous catheter exceed 6 days is not recommended.