1
|
Jeon K, Han SB, Kym D, Kim M, Park J, Yoon J, Hur J, Cho YS, Chun W. Central venous catheter tip colonization and associated bloodstream infection in patients with severe burns under routine catheter changing. Am J Infect Control 2024; 52:813-818. [PMID: 38355049 DOI: 10.1016/j.ajic.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Although routine changing of central venous catheters (CVCs) is commonly performed in patients with severe burns, information on pathogen colonization of the CVC tip and associated bloodstream infections (BSIs) is limited in those patients. 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 ≥30% (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.
Collapse
Affiliation(s)
- Kibum Jeon
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Laboratory Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Seung Beom Han
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Pediatrics, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea.
| | - Dohern Kym
- Infection Prevention and Control Unit, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea; Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Myongjin Kim
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jongsoo Park
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jaechul Yoon
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jun Hur
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Yong Suk Cho
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Wook Chun
- Department of Surgery and Critical care, Burn Center, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| |
Collapse
|
2
|
Nazemidashtarjandi S, Muldur S, Supple MD, Ryan CM, Yonker LM, Karabacak MN, Goverman J, Yarmush M, Irimia D. Monocyte Anisocytosis Changes in Patients after Major Burn Injuries. J Burn Care Res 2024:irae088. [PMID: 38783715 DOI: 10.1093/jbcr/irae088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Indexed: 05/25/2024]
Abstract
The recovery of patients after severe burns is a long and complex process. Recently, genomic analysis of white blood cells from burn and trauma patients revealed excessive and prolonged innate immune activation in patients with complicated outcomes. However, translating this knowledge into practical biomarkers has not been possible yet. Although several biomarkers for monitoring burn patients have been proposed, their ability to accurately distinguish between inflammation stemming from initial tissue destruction, infections, and organ failure complications is limited. Here, we focused on monocytes, critical innate immune cells in the response to burn injured tissues. We measured the monocyte anisocytosis (quantified as monocyte distribution width, MDW, a recently emerged marker of sepsis) throughout the recovery of patients from the time of burn injury until the end of the hospital stay. We observed that MDW increases in patients during the first week after major burns. Among the patients with major burns who survive, MDW starts decreasing in the second week and normalizes by the end of the hospital stay. The duration of hospital stay appears to be proportional to how fast MDW decreases during the second week after the injury. We also found that MDW decreases significantly in most patients after excision and debridement surgeries but not after allo- and auto-graft surgeries. Moreover, high MDW values correlated with a higher rate of positive microbiology blood culture samples and respiratory infections. These findings underscore the importance of monitoring MDW as a potential biomarker for the risk of complications during burn patient recovery.
Collapse
Affiliation(s)
- Saeed Nazemidashtarjandi
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Sinan Muldur
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Department of Pediatrics, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
| | - Matthew D Supple
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
| | - Collen M Ryan
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Lael M Yonker
- Department of Pediatrics, Mucosal Immunology and Biology Research Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
| | - Murat N Karabacak
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Jeremy Goverman
- Department of Surgery, Sumner Redstone Burn Center, Massachusetts General Hospital, MA 02114, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Martin Yarmush
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| | - Daniel Irimia
- Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Boston, MA 02129, USA
- Harvard Medical School, Boston, MA 02114, USA
- Shriners Children's Boston, Boston, MA 02114, USA
| |
Collapse
|