195. Retrospective Assessment of Clinical Impact and Mortality of Central Line-Associated Blood Stream Infection at a Regional Burn Center
Session: Poster Abstract Session: Catheter-associated BSIs
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • IDweekAET final.pdf (403.6 kB)
  • Background: It is estimated that burn patients have 5-9 CLABSIs per 1000 central line days. CLABSIs result in increased length of a patient’s hospital stay, healthcare-associated costs, and mortality. It has been estimated that there is a 20% attributable mortality associated with central line infections in ICU patients.

    Methods: A retrospective review of all patients diagnosed with CLABSI using NHSN definitions in the burn ICU between 2006 and 2012 was conducted and demographic, clinical, and outcome data were obtained using electronic medical records.

    Results: 63 CLABSI events occurred among 46 patients. 89% had one central venous catheter while 11% had two or more simultaneous central lines. There were 44 (70%) events in which lines were infected with one type of organism, 13 (20.6%) in which lines were infected with two types, and 6 (9.5%) events in which lines were infected with three types. 18 different organisms were identified in all CLABSI events. The most commonly occurring were methicillin-resistant Staphylococcus aureus (23), Klebsiella pneumonia (19), and Pseudomonas (7). None of the organisms were CDC-defined contaminants. Subclavian triple lumen catheters (TLC) (22), internal jugular TLCs (12), and femoral TLCs (12) were most commonly associated with CLABSI.  The average time from catheter placement to CLABSI was 11.54 days (1-78). Fever within 48 hours of infection was reported in 92% of cases but only 15 (24%) of the episodes were associated with new or higher fever. 29 (46%) of the episodes were associated with multiple blood cultures positive for the same organism and 30 of 45 (66.7%) of catheter tip cultures had a positive catheter tip for the same organism identified in the blood cultures. Repeat CLABSIs occurred in 8 patients. Death within 30 days of CLABSI diagnosis occurred in 6 of 63 episodes for an overall mortality rate of 9.5%. Of the 6 patients who died, 4 had varying degrees of burn injury and 2 had life-threatening skin conditions.

    Conclusion: The mortality rate of 9.5% in this patient population is less than the reported rate of 20% in other ICUs. A larger case-controlled study is needed to better evaluate mortality in this setting.

    Alexandra Thomas, B.A.1, Jonathan M. Zenilman, MD, FIDSA2, Leigh Ann Price, MD2, Kerri Huber, RN, MSN3, Zeina Khouri-Stevens, PhD, RN3, Richard Bennett, MD4, Renee Blanding3 and Geeta Sood, MD2, (1)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (2)Johns Hopkins University School of Medicine, Baltimore, MD, (3)Johns Hopkins Bayview Medical Center, Baltimore, MD, (4)Johns Hopkins Hospital, Baltimore, MD

    Disclosures:

    A. Thomas, None

    J. M. Zenilman, None

    L. A. Price, None

    K. Huber, None

    Z. Khouri-Stevens, None

    R. Bennett, None

    R. Blanding, None

    G. Sood, None

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