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American Journal of Infection Control xxx (xxxx) xxx–xxx

Contents lists available at ScienceDirect

American Journal of Infection Control

journal homepage: www.ajicjournal.org

Major Article

Central venous catheter tip colonization and associated bloodstream

infection in patients with severe burns under routine catheter
changing
Kibum Jeon MD a,b , Seung Beom Han MD, PhD a,c,ÿ, Dohern Kym MD, PhD a,d ,
d d d d
Myongjin Kim MD , Jongsoo Park MD , Jaechul Yoon MD , Jun Hur MD, PhD ,
d d
Yong Suk Cho MD, PhD , Wook Chun MD, PhD
to
Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea b

Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
c
Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea d

Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea

Keywords: Background: Although routine changing of central venous catheters (CVCs) is commonly performed in
Hospital-acquired infection patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream
Infection control
infections (BSIs) is limited in those patients.
Korea
Methods: The medical records of 214 patients with severe burns who underwent routine CVC changing at 7-
day intervals and their results of 686 pairs of CVC tips and concurrent blood cultures were retrospectively
reviewed to evaluate the CVC colonization rate and associated BSI pathogens.
Results: Of the 686 CVCs, 137 (20.0%) were colonized by pathogens, and 81 (59.1%) of them had BSIs
caused by the same pathogen. Nonflame burn (P = .002), total body surface area burn ÿ30% (P = .004),
femoral catheterization (P = .001), CVC changing during pre-existing BSI (P < .001), and renal replacement
therapy (P = .017) were associated with catheter-related BSI in the multivariate analysis. Most BSIs were
caused by Gram-negative bacteria (most commonly Acinetobacter baumannii, Klebsiella pneumoniae, and
Pseudomonas aeruginosa).
Conclusions: The CVC colonization rate in patients with severe burns and routine CVC changing was not
high. Lengthening the CVC duration might be attempted in patients at a lower risk of catheter-related BSI
although further prospective studies are necessary.
© 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All
rights reserved.

BACKGROUND infections, electrolyte imbalance, hematologic abnormalities, and renal

dysfunction, as well as for limited accessibility to peripheral veins due to
Severe burn injuries involving over 15% to 20% of the total body extended cutaneous damage.2 However, CVCs have both drawbacks and
surface area (TBSA) provoke hyper-inflammatory responses, resulting in therapeutic advantages.3 In particular, catheter-re-lated bloodstream
burn shock that requires fluid resuscitation for restoration.1 For massive infection ( CRBSI) is one of the most common hospital-acquired infections
hydration during burn resuscitation, a central venous catheter (CVC) is occurring in the intensive care unit (ICU) alongside pneumonia and urinary
often inserted at the beginning of the burn resuscitation. The CVC should tract infection; Therefore, guidelines to prevent CRBSI have been
be maintained during critical care for medication administration for pain established.4
control, parenteral nutrition, blood transfusion, and correction of various Patients with severe burns are at an increased risk for infection
5 Further-
complications, including due to the destruction of the cutaneous physical barrier.
more, extensive burns may lead to the CVC's insertion through or near the
burn wound, resulting in increased contamination of a CVC and subsequent
ÿ Address correspondence to Seung Beom Han, MD, PhD, Department of Pediatrics, bloodstream infection (BSI).5 Therefore, general re-commendations for
Hangang Sacred Heart Hospital, College of Medicine, Hallym University, 12 Beodeunaru-ro preventing CRBSI may not apply to patients with severe burns . Although
7-gil, Yeongdeungpo-gu, Seoul 07247, Republic of Korea.
the guidelines recommend not changing CVCs routinely,
E-mail address: beomsid@catholic.ac.kr (SB Han). 4
Conflicts of interest: None to report. CVC routine changing at an interval of 3 to 14 days

https://doi.org/10.1016/j.ajic.2024.02.003
0196-6553/© 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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2 K. Jeon et al. / American Journal of Infection Control xxx (xxxx) xxx–xxx
have been performed in 71.1% of the burn centers in the United States.6 However,
routine CVC changing in patients with severe burns exhibited inconsistent effects on
reducing the incidence of pathogenic CVC colonization and CRBSI in previous reports,
and the appropriate interval for CVC changing has not been defined.7–11
Furthermore, frequent CVC changing can increase the number of in-vasive
procedures, the incidence of mechanical complications asso-ciated with CVC
insertion, medical costs, and health care workers' workload.
Our hospital is the only university-affiliated burn center in Korea that cares for
patients with severe burns, and routine CVC changing is performed at 7-day intervals.
We investigated the results of tip cultures of routinely changed CVCs and blood
cultures performed concurrently with CVC changing (within 2 days before or after
CVC changing) in patients with severe burns admitted to the burn ICU (BICU) for
acute burn care. The study results can help establish ap-propriate infection prevention
and control (IPC) strategies to prevent CRBSI and estimate the usefulness of routine
CVC changing in patients with severe burns.
METHODS
Subject and study design
Electronic medical records of 564 patients with acute burn in-juries and admitted
to the BICU of Hallym University Hangang Sacred Heart Hospital between January
2020 and February 2023 were retrospectively reviewed. Peripherally inserted central
catheters were included in the analysis, whereas hemodialysis and arterial catheters
were excluded (Fig 1). Excluding 130 (23.0%) patients in whom a CVC was not
inserted during BICU care and those who died (n = 29, 5.1%) or transferred to other
hospitals (n = 3, 0.5%) within 2 days after CVC insertion, the remaining 402 (71.3%)
patients in whom CVCs were maintained for 2 days or more were recruited.
Twenty-four (4.3%) patients transferred from other hospitals were excluded because
of insufficient information on the insertion date and duration of CVCs in the previous
hospitals. Among the re-maining 378 (67.0%) patients with CVCs for 2 days or more,
tip cultures of the removed CVCs at routine changing were not per-formed in 104
(18.4%) patients, blood cultures were not performed concurrently with CVC changing
in 35 (6.2%) patients, and blood cultures were performed using samples collected
from existing CVCs in 25 (4.4%) patients. Excluding these patients, the remaining
214 (37.9%) patients were included in the study analyses; they had at least one CVC
in which blood cultures collected by a new veni-puncture within 2 days before or after
CVC changing were performed concurrently with a tip culture.
The Electronic medical records of the included patients were retrospectively
reviewed to collect demographic data, including sex and age, and clinical data,
including burn characteristics (type, % of TBSA burn [%TBSA], and inhalation injury),
catheter characteristics (location, duration, and number of inserted catheters), and
clinical severity (oxygen therapy, mechanical ventilator care, renal replacement-ment
therapy, and in-hospital death). Tip colonization was defined when a positive tip
culture result of a removed CVC was identified at routine changing of the CVC. CRBSI
was defined as the identification of the same pathogen from the tip culture and
concurrently per-formed blood cultures (within 2 days before or after CVC changing).
Tip colonization and CRBSI rates for the CVCs removed during rou-tine changing
were calculated. The investigated variables were compared between CVCs with and
those without CRBSI to determine CRBSI risk factors. The distribution of tip-colonized
pathogens was also compared between CVCs with and those without CRBSI. This
study was approved by the Institutional Review Board of Hallym
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University Hangang Sacred Heart Hospital with a waiver for ac-quiring informed
consent (approval No.: HG 2023-008).
Microbiological testing
The CVC tip cultures were performed using the roll-plate method.
After disinfecting the skin around the CVC insertion site, the CVC was removed, and
the distal 5 cm part of the CVC tip was cut using sterile scissors. The specimen was
placed in a sterile container and transported to the laboratory as soon as possible.
The tip was in-oculated on 5% sheep blood agar and rolled on a plate 4 to 5 times.
The agar plates containing the CVC tip were incubated in 5% CO2 at 35 °C for 24
hours, and then, the number of micro-organisms in the plates was measured: tip
culture positivity was defined when 15 or more colony-forming units in each plate was
identified. Pathogen identification and antibiotic susceptibility tests were performed
using the BD Phoenix M50 system (BD Diagnostics).
Blood samples for cultures were collected using a new veni-puncture procedure
when the CVC was changed. Aerobic and anaerobic bottles (BD BACTEC, Becton
Dickinson) containing 5 mL of blood each were incubated in an automated system
(BACTEC FX, Becton Dickinson). Pathogen identification and antibiotic susceptibility
tests were performed using the BD Phoenix M50 system (BD Diagnostics). Blood
culture positivity was defined when a pathogen was identified in one or more blood
samples, or a common com-mensal (coagulase-negative staphylococci, ÿ-hemolytic
streptococci except S pneumoniae, Bacillus spp., Micrococcus spp., Corynebacterium
spp., Diphtheroids , Arcanobacterium spp., etc.) was identified in two or more blood
samples collected separately.
Central venous catheter care
In our hospital, a chlorhexidine/silver sulfadiazine-impregnated double-lumen or
triple-lumen catheter (Arrowg+ard Blue Plus CVC, Teleflex Inc) was inserted using
maximal sterile barrier precautions under ultrasound guidance. For the CVC insertion
site, a chlorhex-idine-impregnated transparent dressing (Tegaderm CHG, 3M) was
changed daily or when the dressing became damp, loosened, or soiled, even within
a day. Each CVC was recommended to be changed routinely at 7-day intervals or
when complications or CRBSI were suspected, regardless of the catheter duration.
Statistical analysis
Categorical and continuous variables were compared between CVCs with and
those without CRBSI using the ÿ2 test and Mann-Whitney U test, respectively. All
continuous variables did not show a normal distribution in a Kolmogorov-Smirnov test.
Significant variables in this univariate analysis were subjected to multivariate analysis
using a binary logistic regression test to determine the in-dependent factors for
CRBSI. The distribution of tip-colonized pa-thogens between CVCs with and those
without CRBSI was compared using the ÿ2 test. Statistical analyzes were performed
using SPSS 27 (IBM Corp), and statistical significance was defined as a 2-tailed P-
value below .05.
RESULTS
Of the 214 included patients, most (78.0%) experienced flame burns, and the
median of %TBSA was 39% (range 1-98; Table 1). A total of 1,037 CVCs were
maintained for 6,993 days in these 214 patients. A median of 4 CVCs (range 2-17)
was maintained for a median of 29 days (range 7-124) in each patient. Among the
1,037 CVCs, tip and blood culture results were analyzed for 686 (66.2%)
CVCs in which concurrent tip and blood cultures were performed.
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K. Jeon et al. / American Journal of Infection Control xxx (xxxx) xxx–xxx 3

Fig. 1. Flowchart for the study population. BICU, burn intensive care unit; CVC, central venous catheter.

Characteristics of changed central venous catheters
Each of the 686 CVCs was maintained for a median of 8 days (range
2-24). The median durations of CVCs with CRBSI and those without
CRBSI were 8 days (range 4-16) and 8 days (range 2-24), respectively
(P = .666; Table 2). Tip colonization was identified in 137 (20.0%) CVCs,
of which 101 (73.7%) had BSI: the same pathogen in the tip and blood
cultures in 81 (59.1%) and different pathogens in the tip and blood
cultures in 20 (14.6 %) CVCs. Of the 81 CVCs with CRBSI, 37 (45.7%)
had been changed during a pre-existing BSI caused by the same
pathogen identified by the type and blood cultures.
CVCs with CRBSI showed a higher frequency of nonflame burns (P
= .007), higher %TBSA (P < .001), and a higher proportion of fe-moral
catheters (P = .027) than CVCs without CRBSI (Table 2) . CRBSI
was more frequently identified in CVCs that changed during pre-existing
BSI (P < .001) and in the CVCs of patients receiving renal replacement
therapy (P < .001; Table 2). In the multivariate analysis, nonflame burns,
%TBSA ÿ30%, femoral catheterization, pre-existing BSI, and renal
replacement therapy were independently associated with CRBSI
development (Table 3).
Pathogen distributions
A total of 149 pathogens were identified in 137 colonized tips, and 2
were concurrently identified in 12 (8.8%) tips. Of the identified 149
pathogens, Gram-negative bacteria comprised 81.2%, followed by
Candida spp. (12.8%) and Gram-positive bacteria (6.0%; Table 4).
As a single pathogen, Acinetobacter baumannii (32.9%), Klebsiella

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4 K. Jeon et al. / American Journal of Infection Control xxx (xxxx) xxx–xxx

Table 1 Table 3
Characteristics of the 214 patients with severe burns Multivariate analysis for CRBSI risk factors among routinely changed CVCs

Factor Number (%) Factor Odds ratio 95% confidence P-value

interval
Sex
male 167 (78.0) Nonflame burn 2,486 1,392-4,441 .002
Female 47 (22.0) TBSA burned ÿ30% 2,519 1,334-4,757 .004
Age in years, median (range) 58 (6-95) Femoral catheter 3,638 1,751-7,557 .001
Burn type Pre-existing BSI on insertion 10,139 5,530-18,592 < .001
Flame 167 (78.0) Renal replacement therapy 2,450 1,173-5,118 .017
Scald 21 (9.8)
BSI, bloodstream infection; CVC, central venous catheter; CRBSI, catheter-related bloodstream infection;
electric 16 (7.5)
TBSA, total body surface area.
Contact 7 (3.3)
Chemical 3 (1.4)
Inhalation injury 101 (47.2) Table 4
TBSA burn in %, median (range) 39 (1-98)
Distribution of tip-colonized pathogens
Number of catheters, median (range) 4 (2-17)
Duration of catheterization in days, median (range) 29 (7-124) Pathogen Total (n = 149) CVCs without CVCs with
Death 70 (32.7) CRBSI (n = 68) CRBSI (n = 81)

TBSA, total body surface area. Gram-negative bacteria 121 (81.2) 54 (79.4) 67 (82.7)
Acinetobacter baumannii 49 (32.9) 20 (29.4) 29 (35.8)
Pseudomonas aeruginosa 23 (15.3) 18 (26.5) 5 (6.2)
Table 2 Enterobacteriales 48 (32.0) 15 (22.1) 33 (40.7)
Comparison of characteristics between CVCs with CRBSI and those without CRBSI Klebsiella pneumoniae 36 (24.0) 9 (13.2) 27 (33.3)
Klebsiella aerogenes 2 (1.3) 2 (2.9) 0 (0.0)
Factor CVCs without CVCs with P-value Klebsiella oxytoca 1 (0.7) 0 (0.0) 1 (1.2)
CRBSI (n = 605) CRBSI (n = 81) Serratia marcescens 3 (2.0) 0 (0.0) 3 (3.7)
Proteus mirabilis 3 (2.0) 1 (1.5) 2 (2.5)
male sex 485 (80.2) 65 (80.2) .986
Escherichia coli 1 (0.7) 1 (1.5) 0 (0.0)
Age in years, median 59 (6-95) 54 (8-89) .248
Providencia spp. 1 (0.7) 1 (1.5) 0 (0.0)
(range)
Morganella morganii 1 (0.7) 1 (1.5) 0 (0.0)
Burn type .007
Pasteurella multocida 1 (0.7) 1 ( 1.5) 0 (0.0)
Flame 484 (80.0) 50 (61.7)
Gram-positive bacteria 9 (6.0) 9 (13.2) 0 (0.0)
Scald 42 (6.9) 12 (14.8)
Staphylococcus aureus 1 (0.7) 1 (1.5) 0 (0.0)
electric 45 (7.4) 11 (13.6)
Coagulase-negative 6 (4.0) staphylococci 6 (8.8) 0 (0.0)
Contact 24 (4.0) 6 (7.4)
Chemical 10 (1.7) 2 (2.5)
Arcanobacterium 1 (0.7) 1 (1.5) 0 (0.0)
Inhalation injury 299 (49.4) 36 (44.4) .400
haemolyticum
TBSA burn in %, median 38 (1-98) 45 (3-86) < .001
Clostridium spp. 1 (0.7) 1 (1.5) 0 (0.0)
(range)
Candida spp. 19 (12.8) 5 (7.4) 14 (17.3)
Catheter location .027
Femoral 400 (66.1) 67 (82.7) CVC, central venous catheter; CRBSI, catheter-related bloodstream infection.
Subclavian 136 (22.5) 10 (12.3)
Jugular 67 (11.1) 4 (4.9)
PICC 2 (0.3) 0 (0.0)
Catheter duration in days, 8 (2-24) 8 (4-16) .666 colonized by pathogens, and 59.1% (n = 81) of the 137 colonized CVCs
median (range) had CRBSI. CRBSI was identified in 11.8% (81/686) of routinely changed
Catheter order 1 2 .515 CVCs; 8 of 9 CVCs routinely changed might not need to be removed.
156 (25.8) 20 (24.7) Pathogens colonizing CVCs were similar to those known to cause burn
138 (22.8) 14 (17.3)
3-4
wound infections, such as P aeruginosa and A bau-mannii,
153 (25.3) 26 (32.1) 12
ÿ5 158 (26.1) 21 (25.9) rather than those known to cause CRBSI in general patients,
Pre-existing BSI on 35 (5.8) 37 (45.7) < .001 such as Staphylococcus spp.13
insertion
Previous studies reported 26% to 50% of CVC tip colonization rates in
Oxygen therapy 592 (97.9) 79 (97.5) .694
burn patients.11,14–16 These studies were performed 1 to 3 decades ago,
Ventilator care 321 (53.1) 47 (58.0) .400
Renal replacement 55 (9.1) 20 (24.7) < .001 during which several IPC measures for CVC manage-ment and
therapy environmental control were introduced. Therefore, a de-crease in the tip
Death 128 (21.2) 27 (33.3) .014 colonization rate in this study seems inevitable.
BSI, bloodstream infection; CVC, central venous catheter; CRBSI, catheter-related bloodstream infection; Although the CRBSI rate in burn patients was reported to be up to 15 times
PICC, peripherally inserted central catheter; TBSA, total body surface area. higher than that in medical ICU patients in the 1980s,3 recent tip colonization
rates in general ICU patients were reported to be 17% to 18%,17–19 similar
to that observed in our patients. Some randomized controlled trials (RCTs)
pneumoniae (24.0%), and Pseudomonas aeruginosa (15.3%) were on general ICU patients reported a lower rate (8.9%) of tip colonization20;
identified most commonly (Table 4). The distribution of the identified However, a multicenter retrospective study, which is more likely to
pathogens was significantly different between CVCs with CRBSI and those represent real-life clinical settings than an RCT, reported a tip colonization
without CRBSI (P < .001). None of the CVCs colonized by Gram-positive rate of 30.6% in removed CVCs.21 In the nontunneled short-term catheters
bacteria were accompanied by CRBSI, whereas En-terobacterales and used in our patients, CRBSI was preceded by tip colonization following the
Candida spp. colonized significantly more CVCs with CRBSI than those extraluminal transmission of skin-colonized pathogens.3 Similar tip
without CRBSI (P < .001; Table 4). colonization rates between our patients and general ICU patients can
indicate no significant defects in CVC management at our hospital.
DISCUSSION
Therefore, patients with severe burns in the BICU, where various IPC
In this study of patients with severe burns, 20.0% (n = 137) of 686 measures have been applied, might not require IPC strategies for CVC
CVCs routinely changed at a median of 8-day intervals were management that differ from those applied in general ICU patients.

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K. Jeon et al. / American Journal of Infection Control xxx (xxxx) xxx–xxx
The median indwelling duration of each CVC in this study (8 days) did not appear to be
inappropriately short, considering the mean CVC duration of 5 to 13 days in other
prospective/retrospective studies in which CVCs were changed when indicated rather
than routinely.
18–20
Although the CVC duration was not significantly as
associated with the development of CRBSI in this study, previous studies reported that tip
colonization and CRBSI rates significantly increase 8 to 10 days after CVC insertion in
patients with severe burns.22,23 Therefore, CVC duration could be selectively extended
in patients at a lower risk of CRBSI rather than universally extended in all patients with
severe burns.
Nonflame burn, %TBSA ÿ30%, and renal replacement therapy were independently associated with CRBSI development among tip-
colonized CVCs in this study: CVC duration can be extended to more than 7 days preferably in patients with flame burns involving <
30% of TBSA . Femoral catheterization and CVC changing during pre-existing BSI were also associated with CRBSI development, and
these are modifiable factors. Although the recommendation strength was lowered from avoiding femoral vein access to preferring sub-
clavian vein access in the guidelines for preventing CRBSI,4 a higher frequency of infectious complications in femoral catheterization 24
than in subclavian catheterization has been observed in an RCT.
BSI
was accompanied by 20% and 45% of colonized CVCs in patients with burns in whom
femoral catheters were inserted in one-third and 11,14 In this study, femoral ca-two-thirds
of patients, respectively.
theters comprised 68.1% of the analyzed CVCs. Access to peripheral veins during BSI
and reinsertion of a CVC after sterilization of the blood should be considered, and the
subclavian vein should be preferred to the femoral vein during CVC insertion to prevent
CRBSI and frequent CVC changing. Whether the tip colonizer identified after CVC
changing during pre-existing BSI originated from local infections, such as wound infection
and pneumonia, or from pre-existing bacteria in the bloodstream could not be determined
in this study. Therefore, in a clinical setting, source control for other local infections
should be accompanied with CVC management. The differential time to positivity,
comparing the time to culture positivity from blood samples collected concurrently from
the CVC and per-ipheral vein can be used to screen for CRBSI and reduce unnecessary
CVC changing in patients with severe burns because it showed a favorable negative
predictive value for predicting CRBSI.25
Despite the reduced rate of tip colonization, the CRBSI rate (11.8%) in this study was
similar to those of previous studies on patients with burns, which reported that BSI was
accompanied by 20% to 50% colonized CVC tips.11,14– 16 This was caused by the high
rate of concurrent BSI in the pathogen-colonized CVCs in this study (59.1%), which was
higher than the rate (43.7%) reported in a recent multicenter retrospective study on general
patients.21 CRBSI is conventionally diagnosed when infectious causes other than CVC
are ruled out13 ; However, we did not consider other infectious causes to determine
CRBSI in this study, which likely would increase the CRBSI rate by including secondary
BSI. In patients with severe burns, acute respiratory distress syndrome caused by a
cytokine storm during the hyper-metabolic state after major trauma, pulmonary edema,
and pleural effusion due to massive hydration during burn resuscitation, and pulmonary
injury due to inhalation can be confused with pneumonia .26 Because conventional burn
wound care can provoke secondary BSI regardless of local infection,27,28 secondary BSI
caused by pathogens colonizing burn wounds cannot be differentiated from primary
CRBSI in patients with severe burns in whom local wound care is performed every day. A
baumannii, P aeruginosa, and enteric Gram-negative bacteria were the most common
pathogens causing tip colonization and CRBSI in this study, although Staphylococcus
spp. are well-known conventional CRBSI causes.13 As A baumannii, P aeruginosa, and
K pneumoniae are the most common pathogens identified in patients with burns,12 they
could be highly colonized
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5
around the CVC insertion site, resulting in CVC tip colonization and subsequent CRBSI.
In fact, A baumannii and P aeruginosa have been the major pathogens causing BSI in our
hospital for more than 10 years, and BSI caused by enteric Gram-negative bacteria has
been increasing.29 However, CVCs colonized by Staphylococcus spp., a common skin
commensal, did not accompany CRBSI in this study, while Enterobacterales and Candida
spp., common gastrointestinal commensals, were more likely to colonize CVCs with
CRBSI than CVCs without CRBSI. The CRBSI rate in pathogen-colonized CVC tips could
be accentuated by secondary tip colonization with blood-stream pathogens originating
from other infected or colonized sites.
In patients with severe burns, efforts to reduce BSI caused by the translocation of
gastrointestinal commensal and burn wound colonizers as well as appropriate CVC
management should be considered.
This study has some limitations. Because of its retrospective nature, tip and blood
cultures were not performed systematically; Consequently, 60% of the BICU-admitted
patients were excluded from the study analysis. As many CVCs were changed based on
the patients' clinical conditions, not all CVCs were changed at exact 7-day intervals, and
62.5% of the analyzed CVCs were changed at 7- or 8-day intervals.
As discussed above, infectious causes other than CVC were not considered in determining
CRBSI in this study because of the difficulties in differentiating between other local
infections and complications arising from severe burn injuries. However, the results of this
study are acceptable because most physicians would remove a CVC when the same
pathogen is identified in the CVC type and blood cultures, regardless of the pathogen's
origin. To overcome these limitations, a prospective study with systematic cultures of CVC
tips and peripherally drawn blood samples during CVC changing, and of respiratory
samples and burn wounds to define secondary BSI should be per-formed. Furthermore,
pathogen distribution and antibiotic resistance rates can differ for each hospital; Therefore,
ideally, burn centers would be able to collaborate to help study regional and center-
specific differences.
CONCLUSIONS
In conclusion, the CVC tip colonization rate in patients with severe burns and routine
CVC changing at a median of 8-day intervals was not sufficiently high to recommend
differentiated CVC management strategies. This study suggested that lengthening the
CVC duration might be attempted preferentially in patients at a lower risk of CRBSI;
However, well-controlled prospective studies are needed to determine risk factors and
exact CVC duration for increasing CRBSI rate under consideration of local infectious
causes for BSI.
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