Risk factors for central line-associated bloodstream infection in patients with major burns and the efficacy of the topical application of mupirocin at the central venous catheter exit site

Aim: The aim of this study was to evaluate the efficacy of the topical administration of mupirocin and other practices in central venous catheter (CVC) care to prevent central line-associated bloodstream infections (CLABSI) in patients with major burns. Methods: Patients with major burns admitted to a burn ICU were divided into four groups and disinfected at the CVC exit site with single povidone iodine (PVP-I) or PVP-I plus topical mupirocin ointment three times a day or once a day, respectively. The bacterial colonization of the skin at the CVC exit site and CVC tips and the incidence of CLABSI were recorded, and the risk factors were analyzed. Results: Administering mupirocin (RR = 0.316, p = 0.001), increasing the frequency of insertion-site care (RR = 0.604, p = 0.008), and avoiding cannulation at the burn site (RR = 0.148, p < 0.001) reduced skin colonization at the CVC insertion site. Topical administration of mupirocin significantly reduces both the bacterial colonization rate at CVC tips (RR = 0.316, p = 0.001) and the incidence of CLABSI (5.3 vs. 29.1 per 1000 catheter days, p <0.001). Conclusions: Mupirocin is effective in the prophylaxis of CLABSI. Other CVC care practices were also found to affect the level of bacterial colonization, but their efficacy in preventing CLABSI needs to be evaluated further. (C) 2015 The Authors. Published by Elsevier Ltd and ISBI.