Duration of infusions and blood stream infections in polytrauma patients

Introduction

Central venous catheters (CVCs) are generally used in ICU patients. Nevertheless, bloodstream infections are common and dangerous complications of CVCs. The use of CVCs in ICU patients has contributed to the majority of nosocomial bloodstream infections caused by Staphylococcus aureus, Staphylococcus epidermidis and Candida species. It was shown that more than 200,000 cases of CVC-related bloodstream infections occur annually in the United States, with mortality of 12–25%.

Objective

To evaluate the predictive value of the working time of a central venous line as a risk factor of blood stream infections in polytrauma patients.

Materials and methods

In the period of 1 February 2002 to 30 November 2004, 451 patients with severe polytrauma were admitted to the ICU of Lugansk District Hospital. All of them had CVCs, and the average duration of stay in the ICU was 7.12 days (6–21 days). The working time of the CVC (WT CVC) and incidence of nosocomial blood stream infections were analyzed. Patients who died on the first to third day of hospitalization were excluded from the investigation as inappropriate to nosocomial infection criteria.

Results

WT CVC was measured as the duration of infusions/transfusions during the first 7 days of the post-traumatic period. The incidence of blood stream infections was 21 cases (4.66%). All patients were divided into two groups: Group A, with blood stream infections (21 patients); Group B, patients who have no such complications (430 cases).

WT CVC in Group A and in Group B was 128.1 ± 11.5 hours and 87.5 ± 7.4 hours, respectively (P < 0.05).

Infusions of crystalloids, colloids, blood components and other medications prolonged round-a-day and depended on severity of injury, blood loss volume, and presence of multiple organ dysfunction. Severity of injury measured by the Trauma Score was 8.5 ± 1.1 and 9.7 ± 1.0, respectively (P > 0.05). Blood loss was 2.2 ± 0.6 l and 1.3 ± 0.2 l (P < 0.05), parameters of acute physiology (by SAPS) were 12.8 ± 0.8 and 9.4 ± 1.0, respectively (P < 0.05).

Conclusion

Thus, incidence of blood stream infections depends on the duration of infusions/transfusions in the ICU. The WT CVC is defined by statistically considered factors – blood loss volume and severity of MODS. Severity of trauma is not a predictor of CVC blood infections.