Intravascular catheter-related infections in an Indian tertiary care hospital

Abstract

Introduction: This study had two objectives: 1) to determine the clinical and microbiological profiles of patients developing intravascular catheter-related local (localized catheter colonization and exit site) and systemic infections and their predisposing factors; 2) to study the antibiotic sensitivity patterns of the organisms isolated. Methodology: This case-control study was conducted over 19 months involving 232 patients at a tertiary care hospital. Non-tunneled central venous catheters and midline catheters were the two types studied. Catheter tips were processed using Maki's roll plate and endoluminal flush techniques. Blood cultures were drawn under strict aseptic precautions and processed by the BacT ALERT system. A "case" was any patient with proven localized catheter colonization, exit site infection or blood-stream infection and a "control" was any patient from whom the intravascular catheter yielded no organism in semi-quantitative cultures. Results and Conclusions: The incidence of catheter-related blood-stream infections (CRBSI) in our institute was 8.75 per 1,000 catheter days. The commonest organisms causing local infections were coagulase-negative Staphylococci, and those causing CRBSI were Staphylococcus aureus. Multidrug-resistant organisms accounted for 30.2% of the infections. Risk factors for development of catheter-related infections included an immune compromised state, duration of the catheter in situ, femoral venous cannulation, and triple lumen catheters. Choice of venous cannulation to minimize the risk of catheter-related infection in ascending order for risk of infection is the subclavian vein, jugular vein, basilic vein and then the femoral vein. There was no role for empirical antibiotic therapy to prevent intravascular catheter-related local or systemic infections.

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

“…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.…”

“…M. Kaur et al, [18] Deepti et al, [15] Ramanathan Parameshwaran et al [16] and H. V. Patil et al [19] also showed that MRSA was responsible for majority cases of CRBSI.…”

“…The study conducted by Harsha V Patil [19] showed that 22.22%, 38.89% and 38.89% CVC were placed into internal jugular vein, femoral vein and subclavian vein respectively. The study conducted by Ramanathan Parameswaran [16] showed that 22.2%, 33.3% and 23% CVC were placed into internal jugular vein, femoral vein and subclavian vein respectively.…”

Strategies to Combat Antimicrobial Resistance

“…This may help to reduce the unnecessary use of antibiotics. Parameswaran et al, reported that MDR microbes caused 30.2% of the catheter-related blood-stream infections and empirical treatment had no role in prevention of such infections [29]. This mandates use of aseptic protocol to minimize local or systemic infections associated with any procedures.…”