CENTRAL LINE-RELATED SEPSIS IN ACUTE BURN PATIENTS

A retrospective review of all 443 burn patients admitted during a 13-m onth period from October 1, 1992 to October 31, 1993, was completed. O f these, 8 were transferred and eliminated from the study. Twenty-two patients who were felt to be terminal on admission and did not have bl ood cultures were included in the demographic data but were excluded f rom subsequent statistical analysis. One hundred ten patients had cent ral venous lines (CVLs). Three patients with CVLs were transferred, th us leaving 107 patients with CVLs for statistical analysis. Additional ly, 17 of the aforementioned terminal patients who had CVLs and 1 pati ent with a CVL who had documented sepsis before CVL insertion were exc luded, leaving 89 patients with CVLs used in statistical analysis. Mea n burn surface for those with central lines was 35.8 per cent, and for those without, 10.9 per cent. Sixty-four patients (59.8%) with a cent ral line had inhalation injuries, as did 18 patients (5.5%) without. T he number of lines per patient varied from 1 to 7. Sixty-one patients had one line, 46 had more than one. The total number of central line d ays for the entire group was 1749. The mean number of central line day s per patient was 16.3. The mean number of line days per catheter was 8.48. The mortality rate for the 107 patients with a central line was 34 (32.7%). Mortality for all patients was 41 (9.4%). The incidence of sepsis increased with increasing number of central line days and incr easing number of central line changes, but the effect of these two fac tors on the incidence of sepsis could not be studied separately, as th ey are highly correlated with each other. The most commonly recovered organisms were various types of Staphylococcus. Polymicrobial infectio ns were common. There were 51 subclavian, 17 internal jugular, and 135 femoral catheters inserted. By logistic regression analysis, there wa s no statistically significant difference in the incidence of sepsis b etween upper- and lower-body CVL sites. Twenty-four patients (22.4%) w ith a CVL and one or more positive blood cultures were felt to have de monstrated sepsis. Some had more than one septic episode while lines w ere in place, reported as separate patients but not as separate septic episodes.