Central line associated bloodstream infection rates in 166 intensive care units of 54 cities in 23 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Abstract

During this study period, 7,216 positive blood cultures were identified. Of these, 87 (1.2%) blood cultures from 54 patients showed S. maltophilia growth. The mean age of the patients was 53.3 ± 3.0 years. In 52 patients (96%), S. maltophilia bacteremia was hospitalacquired, in particular, in 49 patients (91%) it developed after prolonged hospitalization of >2 weeks. Forty-one patients (76%) had an indwelling central venous catheter (CVC), 50 (93%) had received antibiotic therapy, 48 (89%) had underlying malignancy, 11 (20%) had diabetes mellitus, and 11 (20%) were receiving corticosteroid therapy. In 19% of all the cases of bacteremia, polymicrobial isolates were confirmed. The overall and bacteremia-related mortality rates were 39% and 26%, respectively. The most common sources of bacteremia were CVC (33%) and pneumonia (15%); the source was unknown in 20% cases. Tests for antibiotic susceptibility revealed that the isolates were most sensitive to trimethoprimsulfamethoxazole (79%). Only 47% and 43% of the isolates were susceptible for ceftazidime and ciprofloxacin, respectively. Univariate analysis revealed that bacteremia originating from the pneumonia, patients treated with inappropriate antibiotics, and patients with a persistent indwelling CVC had a significant higher mortality rate (P < 0.0001, P < 0.0001, P = 0.0027, respectively).Conclusion: S. maltophilia is an important pathogen, particularly, in immunocompromised hosts. Isolation of this organism from a blood culture should prompt a careful review of the patient, with particular emphasis on removal of an indwelling CVC and commencement of appropriate antibiotic therapy. In this study, we noticed an increasing trend of resistance to ceftazidime, cefepime, and ciprofloxacin. Therefore, we believe that proper usage of antibiotics is important for infection control.