title: Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.
abstract: The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.
authors.affiliation: From the *Joseph M. Still Burn Center, Doctors Hospital, Augusta, Georgia; †Joseph M. Still Research Foundation, Inc., Augusta, Georgia; ‡Joseph M. Still Burn Centers, Inc., Augusta, Georgia; and §MED Institute, Inc., West Lafayette, Indiana.
authors.forename: Bruce C
authors.initials: BC
authors.lastname: Friedman
authors.forename: Mohammad A H
authors.initials: MA
authors.lastname: Mian
authors.forename: Robert F
authors.initials: RF
authors.lastname: Mullins
authors.forename: Zaheed
authors.initials: Z
authors.lastname: Hassan
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Shaver
authors.forename: Krystal K
authors.initials: KK
authors.lastname: Johnston
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000209:etiology* / Q000382:microbiology; D002056:Burns / Q000628:therapy*; D055499:Catheter-Related Infections / Q000209:etiology* / Q000382:microbiology / Q000517:prevention & control*; D002405:Catheterization, Central Venous; D062905:Central Venous Catheters; D002648:Child; D020099:Coated Materials, Biocompatible; D016503:Drug Delivery Systems; D005260:Female; D005268:Femoral Vein; D006801:Humans; D008297:Male; D008875:Middle Aged; D008911:Minocycline / Q000008:administration & dosage; D012189:Retrospective Studies; D012293:Rifampin / Q000008:administration & dosage; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D020099:Coated Materials, Biocompatible; D008911:Minocycline; D012293:Rifampin