Central venous catheter-related bloodstream infections in the intensive care unit

Abstract

Context:Central venous catheter-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients.Aims:This study was conducted to determine the incidence of central venous catheter-related infections (CRIs) and to identify the factors influencing it. So far, there are very few studies that have been conducted on CRBSI in the intensive care unit in India.Settings and Design:This was a prospective, observational study carried out in the medical intensive care unit (MICU) over a period of 1 year from January to December 2004.Materials and Methods:A total of 54 patients with indwelling central venous catheters of age group between 20 and 75 years were included. The catheters were cultured using the standard semiquantitative culture (SQC) method. Statistical analysis used SPSS-10 version statistical software.Results:A total of 54 CVC catheters with 319 catheter days were included in this study. Of 54 patients with CVCs studied for bacteriology, 39 (72.22%) catheters showed negative SQCs and also negative blood cultures. A total of 15 (27.77%) catheters were positive on SQC, of which 10 (18.52%) were with catheter-associated infection and four (7.41%) were with catheter-associated bacteremia; the remaining one was a probable catheter-associated bacteremia. CRIs were high among catheters that were kept in situ for more than 3 days and emergency procedures where two or more attempts were required for catheterization (P < 0.05). In multivariate analysis of covariance duration of catheter in situ for >3 days, inexperienced venupucturist, more number of attempts and emergency CVC were associated with more incidence of CVCBSIs, with P <0.02. The duration of catheter in situ was negatively correlated (-0.53) and number of attempts required to put CVC was positively correlated (+0.39) with incidence of CVCBSIs. Sixty-five percent of the isolates belonged to the CONS group (13/20). Staphylococcus epidermidis showed maximum susceptibility to amikacin, doxycycline and amoxycillin with clavulanic acid and was susceptible to vancomycin (100%). Klebsiella pneumoniae was 100% susceptible to amikacin and ciprofloxacin. Escherichia coli was susceptible to amikacin and cefotaxime.Conclusions:The overall incidence of CRI was 27.77% (15/54). Catheter-associated BSIs were 47.31 per 1000 catheter-days. CRI was low in the catheters inserted by the experienced venipuncturists, elective procedure and CVC kept in situ for ≤3 days. S. epidermidis was the most common isolate.

Surveillance of Catheter-Related Bloodstream Infections Among Adult Patients in Icu

“…Other studies conducted by H. V Patil, [19] Deepti et al, [15] showed high CRBSI rate among 50-60 years of age group whereas study done by Manjula et al [21] showed high culture positivity rate between 19-30 years of age group.…”

“…Other studies also showed male predominance like the study done by H.V Patil [19] which showed 59% males and 41% females were affected, the study done by Deepti et al [15] showed 69% males and 31% females affected, the study done by Daniela Bicudo [17] showed 58.85 males and 41.2% females affected and the study by Ramanathan Parameswaran et al [16] showed 72% males and 28% females were affected. CRBSI rates were high in all these studies because of associated or predisposing factors which were seen more in males like smoking, alcohol intake and comorbid illness like HTN, DM, ketoacidosis bronchial asthma, COPD, renal failure, patient on immune suppressive therapy, chemotherapy, etc.…”

“…This is comparable to the National Nosocomial Infection Surveillance (NNSI) System report (2 to 11.3 per 1000 catheter days). [13] Similarly, CRBSI rate in the study of S. Singh et al [14] showed 0.48 per 1000 catheter days, Deepti et al [15] showed 8.2 per 1000 catheter days, Ramanathan Parameswaran et al [16] was 8.75 per 1000 catheter days, Daniela Bicudo [17] showed 10.22 per 1000 catheter days, M. Kaur [18] showed 14.59 per 1000 catheter days, Harsha V Patil [19] showed 47.31 per 1000 catheter days. Total 150 catheter samples included in this study.…”

Phenotypic Characterization and Susceptibility Pattern of Gram Negative Bacterial Isolates from Cases of Central Line Associated Blood Stream Infections in a Tertiary Care Institute

“…Results are not consistent with the findings of other observers. 8,[20][21][22][23] All the isolates of K. pueumoniae were resistant to ampicillin and amoxicillin/clavulanic acid. Amikacin was resistant to (58.33%) isolates and was lowest among all commonly used antibiotics.…”

“…2 Data regarding the incidence, prevalence, epidemiology, aetiology and susceptibility pattern of isolates are frequently available from the resource rich countries but same is not true for resource poor countries. [3][4][5][6][7][8] Both gram positive and gram negative organisms are responsible for CLABSI. Gram positive cocci (both Staphylococcus aureus and the coagulasenegative staphylococci) are the leading causes of CLABSI followed by Gram negative bacilli.…”