IDENTIFY THE RISK FACTORS AND MORTALITY ASSOCIATED WITH CENTRAL LINE-ASSOCIATED BLOODSTREAM INFECTION (CLABSI)
Main Article Content
Keywords
Intensive care unit, bloodstream infection, CLABSI, Blood/tip culture, mortality
Abstract
Background: Central line-associated bloodstream infection is the most common hospital-acquired infection and is associated with high morbidity and mortality along with increased healthcare cost. However, studies on the incidence of nosocomial infections are very limited in India.
Aim: To determine the incidence of central line-associate bloodstream infection (CLABSI), microorganisms associated in the medical ICU of a tertiary care hospital.
Methods: A total of 100 patients who were admitted to the medical ICU and had a central venous catheter (CVC) implanted at admission in the emergency department or in the medical ICU for longer than 48 hours were monitored. By examining the blood culture reports, the patients were monitored every day for the emergence of new-onset sepsis after 48 hours following CVC insertion. The data were evaluated statistically using Microsoft Excel and SPSS version 22.0 (IBM Corp., Armonk, NY, USA).
Results: Out of 100 catheterized patients, 30were positive cultures. 20 patients were positive for blood culture and 12 were positive for tip culture (2 patients were positive for both blood culture and tip culture). Out of 30 cases, 21 males and 9 females tested positive for blood/tip culture. Males were at higher risk for blood/tip culture in CVC patients than females. The age groups >18-30 years and 51-60 years showed statistically significant differences in blood/tip culture in CVC patients. Blood/tip culture was found to be statistically significant in CVC patients with acute severe pancreatitis, chronic kidney disease as well as Guillain-Barre syndrome. While as, comorbidities, T2DM was statistically significant for blood/tip culture. The Mean ± S.D. for positive blood/tip cultures with CVC duration <10 days and ≥10 days was 6.5 ± 1.43 and 12.15 ± 2.23, respectively. For negative blood/tip cultures, the Mean ± S.D. for <10 days and ≥10 days was 5.13 ± 1.63 and 10.53 ± 0.57, respectively. The duration of CVC days was statistically significant. Thus, the incidence rate of central line-associated bloodstream infection (CLABSI) was 18.31 per 1000 central line days. Majority of the cultures were from (n=70) No CLABSI/CRBSI, CLABSI (n=18), Catheter Tip Colonization (n=10) and CRBSI (n=2) (p-value < 0.05). The prevalence of pathogenic isolates was Staphylococcus aureus 8 (26.70%), Klebsiella pneumonia 5 (16.70%), Pseudomonas aeruginosa 5 (16.70%), Escherichia coli 4 (13.30%), Acinetobacter baumanni3 (10.00%), Burkholderia species 3 (10.00%) andEnterococcus 2 (6.60%) respectively (p-value < 0.05). The mortality rate was 7.0%. Patients with a positive culture had a significantly higher mortality rate (5/30 = 16.70%) than those with a negative culture (2/70 = 2.90%) (p-value = 0.013).
Conclusion: The prevention of CLABSI requires knowledge of the infection rates and of the sources, the pathogens involved as well as their antimicrobial profile. Due to rising antimicrobial resistance, surveillance programs are crucial in establishing the species distribution and resistance patterns of bacteria causing BSIs and thus providing the basis for appropriate empirical therapy.
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Dr. Aarif Ahmad Teli
Postgraduate Scholar, Department of Anaesthesiology & Critical care medicine, Government Medical College, Srinagar, India.
Dr. Saba Ahad
Assistant Professor, Department of Anaesthesiology & Critical Care Medicine, Government Medical College, Srinagar, India.
Dr Mohammad Ommid
Professor, Department of Anesthesiology & Critical Care Medicine, Government Medical College, Srinagar
Dr. Farhana Bashir
Assistant Professor, Anesthesiology & Critical Care Medicine, Government Medical College, Srinagar, India.