Central venous catheter related blood stream infection in tertiary care hospital

Ankita R. Sawant; Anita A. Paritekar

doi:10.18203/2320-6012.ijrms20241896

Authors

Ankita R. Sawant Department of Medicine, RCSM GMC and CPR Hospital, Kolhapur, Maharashtra, India
Anita A. Paritekar Department of Medicine, RCSM GMC and CPR Hospital, Kolhapur, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20241896

Keywords:

Bacteremia, Central venous catheter, Catheter-related infections

Abstract

Background: Central venous catheter-related bloodstream infections (CRBSIs) are associated with significant morbidity and mortality in hospitalized patients. Understanding the incidence and risk factors associated with CRBSIs is crucial for implementing effective preventive strategies. The study aimed to examine the incidence and risk factors associated with central venous CRBSIs in a tertiary care hospital setting.

Methods: A prospective observational study was conducted at a tertiary care hospital to investigate the incidence and risk factors of CRBSIs. Patients aged >18 years with a central venous catheter inserted for >48 hours were included. Clinical and microbiological data were collected, and CRBSI rates were calculated. Statistical analysis was performed using SPSS V 23.0.

Results: A total of 50 patients were recruited, with 11 diagnosed with CRBSIs. The incidence of CRBSIs was 8.1 per 1000 central line days and 5.7 per 1000 inpatient days, with a Device Utilization Ratio (DUR) of 0.7. Male gender and older age (>40 years) were significantly associated with CRBSIs (p<0.05). Gram-negative microorganisms were the most commonly isolated pathogens (63.63%), followed by Gram-positive organisms (27.27%) and Candida species (9.09%). Immune system status (p=0.0372) and duration of catheterization (P=0.0035) were found to have a significant association with CRBSI. Mortality was higher in patients with CRBSIs compared to those without (45.45% vs. 28.21%).

Conclusions: CRBSIs remain a significant concern in tertiary care hospitals, with Gram-negative organisms being the predominant pathogens. Male gender and older age were identified as risk factors for CRBSIs. Effective infection control measures targeting high-risk populations are warranted to reduce the incidence of CRBSIs and improve patient outcomes.

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References

Deb M, Mittal G, Gaind R, Verma PK. Central venous catheter related blood stream infections in an intensive care unit from a tertiary care teaching hospital. Int J Infect Control. 2016;12(1).

Negi N, Gupta S, Chandola I, Kataria V. Prevalence of central line associated blood stream infection (CRBSI) and catheter colonization in ICU settings of a tertiary care hospital in sub-Himalayan region. Trop J Pathol Microbiol. 2019;5(10):815-821.

Bell EC, Chapon V, Bessede E, Meriglier E, Issa N, Domblides C, et al. Central venous catheter-related bloodstream infections: Epidemiology and risk factors for hematogenous complications. Infect Dis Now. 2024;54(3):104859.

Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O'Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45.

Sousa B, Furlanetto J, Hutka M, Gouveia P, Wuerstlein R, Mariz JM, et al. Central venous access in oncology: ESMO Clinical Practice Guidelines. Ann Oncol. 2015;26:v152-68.

Lorente L, Henry C, Martín MM, Jiménez A, Mora ML. Central venous catheter-related infection in a prospective and observational study of 2,595 catheters. Critical care. 2005;9:1-5.

Buetti N, Priore EL, Atkinson A, Widmer AF, Kronenberg A, Marschall J. Catheter-related infections: does the spectrum of microbial causes change over time? A nationwide surveillance study. BMJ open. 2018;8(12):e023824.

Bhavana C, Nagarathnamma T, Ambica R. Study of centralline associated blood stream infections (CLABSIs) and central-line related blood stream infections (CRBSIs) in a tertiary hospital, Bangalore, India. Int J Curr Microbiol Appl Sci. 2018;7(05):697-707.

Mathur P. Prevention of healthcare-associated infections in low-and middle-income countries: The ‘bundle approach’. Ind J Medi Microbiol. 2018;36(2):155-62.

Maki DG, Weise CE, Sarafin HW. A semi-quantitative culture method for identifying intravenous-catheter related infection. New Engl J Medi. 1977;296(23):1305-9.

Procop GW, Church DL, Hall GS, Janda WM. Koneman's color atlas and textbook of diagnostic microbiology. Jones & Bartlett Learning; 2020.

Clinical and Laboratory Standards Institute (CLSI): Performance Standards for Antimicrobial Susceptibility Testing, 29th ed. Clinical and Laboratory Standards Institute, Wayne, PA; 2019.

Bloodstream Infection Event (Central Line-Associated Bloodstream Infection and Non-central Line Associated Bloodstream Infection), 2024. Available at: https://www.cdc.gov/nhsn/pdfs/pscmanual/4psc_clabscurrent.pdf?utm_medium=email&utm_source=transaction. Accessed 29 April 2024.

Maqbool S, Sharma R, MAQBOOL S. Incidence of central line-associated bloodstream infection in a tertiary care hospital in Northern India: a prospective study. Cureus. 2023;15(8): e44501.

Masih SM, Goel S, Singh A, Khichi SK, Vasundhara, Tank R. Epidemiology and risk factors of healthcare associated infections from intensive care unit of a tertiary care hospital. Int J Res Med Sci. 2016;4(5):1706-10.

Centers for Disease Control and Prevention Vital signs: central line-associated blood stream infections United States, 2001, 2008, and 2009. Ann Emerg Med. 2011;58(5):447-50.

Endimiani A, Tamborini A, Luzzaro F, Lombardi G, Toniolo A. A two-year analysis of risk factors and outcome in patients with bloodstream infection. Jpn J Infect Dis. 2003;56(1):1-7.

Dasgupta S, Das S, Chawan NS, Hazra A. Nosocomial infections in the intensive care unit: Incidence, risk factors, outcome and associated pathogens in a public tertiary teaching hospital of Eastern India. Indian J Crit Care Med. 2015;19(1):14-20.

Mathur P, Varghese P, Tak V, Gunjiyal J, Lalwani S, Kumar S, et al. Epidemiology of blood stream infections at a level-1 trauma care center of India. J Lab Physicians. 2014;6(1):22-27.

Khurana S, Bhardwaj N, Kumari M, Malhotra R, Mathur P. Prevalence, etiology, and antibiotic resistance profiles of bacterial bloodstream infections in a tertiary care hospital in Northern India: a 4-year study. J Lab Physicians. 2018;10(4):426-31.

Goldmann DA, Pier GB. Pathogenesis of infection related to intravascular catheterization. Clin Microbiol Rev. 1993;6(2):176-192.

Wassil SK, Crill CM, Phelps SJ. Antimicrobial impregnated catheters in the prevention of catheter-related bloodstream infection in hospitalized patients. J Pediatr Pharmacol Ther. 2007;12(2):77-90.

Pandit P, Sahni AK, Grover N, Dudhat V, Das NK, Biswas AK. Catheter-related blood stream infections: prevalence, risk factors and antimicrobial resistance pattern. Medi J Arm Forc India. 2021;77(1):38-45.

Johnston BL, Conly JM. What do central venous catheter-associated bloodstream infections have to do with bundles? Can J Infect Dis Med Microbiol. 2005;16(4):215-218.

Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-71.

Kumar A, Sharma R.M, Jaideep CN, Hazra N. Diagnosis of Central venous catheter-related bloodstream infection without catheter removal: a prospective observational study. Med J Armed Forces India. 2014;70(1):17-212.

Patil HV, Patil VC, Ramteerthkar MN, Kulkarni RD. Central venous catheter related bloodstream infections in the intensive care unit. Indian J Crit Care Med. 2011;15(4):213-23.

Mishra SB, Misra R, Azim A, Baronia AK, Prasad KN, Dhole TN, et al. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Heal Care. 2017;29(1):63-7.