title: Central Venous Catheter-Related Infection in Severe Trauma Patients.
abstract: OBJECTIVE
  To evaluate the CVC-related infection rate according to catheter insertion site and to analyze the risk factors for catheter-related local infections (CRLI) and bloodstream infections (CRBSI) among severe trauma patients.
  
  
  METHODS
  We reviewed the medical records of 736 severe trauma patients with an Injury Severity Score of >15. Poisson regression was used to compare the infection rates according to the catheter insertion sites. Univariate analysis of the groups with and without CVC-related infection was used to identify confounding variables for inclusion in multivariate models that were used to identify the risk factors for CRLI and CRBSI.
  
  
  RESULTS
  We evaluated 1646 catheter insertions and their duration of insertion and found 1241 subclavian (18,461 days), 251 internal jugular (3454 days), and 154 femoral catheters (1526 days). The CRLI infection rate per 1000 catheter days was significantly lower for subclavian, compared to that for internal jugular (4.83 vs. 9.55, respectively; P < 0.001) and femoral catheters (4.83 vs. 7.93, respectively; P = 0.013). Multivariate logistic regression analysis revealed that catheter insertion duration [odds ratio (95 % confidence interval): 1.035 (1.021-1.050), P < 0.001] and subclavian access [0.532 (0.366-0.775), P < 0.001] were significantly associated with CRLI, while catheter insertion duration [1.024 (1.002-1.046), P = 0.032] was significantly associated with CRBSI.
  
  
  CONCLUSIONS
  To reduce the rate of CVC-related infections in severe trauma patients, we suggest that catheters be shifted from the internal jugular or femoral veins to the subclavian vein as soon as possible and that the duration of catheter insertion should be minimized.
authors.affiliation: Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 206 World cup-ro, Yeoungtong-gu, Suwon, 443-749, Korea.
authors.forename: Seok Hwa
authors.initials: SH
authors.lastname: Youn
authors.forename: John Cook-Jong
authors.initials: JC
authors.lastname: Lee
authors.forename: Younghwan
authors.initials: Y
authors.lastname: Kim
authors.forename: Jonghwan
authors.initials: J
authors.lastname: Moon
authors.forename: Younghwa
authors.initials: Y
authors.lastname: Choi
authors.forename: Kyoungwon
authors.initials: K
authors.lastname: Jung
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000209:etiology* / Q000382:microbiology; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005268:Femoral Vein; D006801:Humans; D015601:Injury Severity Score; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013350:Subclavian Vein; D013997:Time Factors; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult