Prevalence of meticillin resistant Staphylococcus aureus and coagulase negative staphylococci bacteremia and nasal carriage in a tertiary care hospital, South India

Abstract

Background: Indian data on CLABSI in PICU is scarce. Most of the reported studies are on CRBSI or they have shown combined adult, pediatric and neonatal data.Methods & Materials: We conducted a retrospective study of PICU records of the 5-year study period (January 2010 -December 2014. Patients with Central Venous Catheters (CVCs) were identified. Patients with incomplete medical records or CVCs in situ for duration less than 48 hours were excluded. CLABSI was identified by the CDC definition. Demographic, disease related and catheter related factors were compared between the CLABSI and non-CLABSI groups. Outcomes studied were length of hospital, PICU stay and mortality. The profile of organisms causing CLABSI was studied.Results: A total of 248 patients satisfied the inclusion criteria . 55 patients were excluded (Incomplete records = 14, Duration of CVC < 48 hours = 41). 21 CLABSIs occurred during the study period. Multiple CVCs, neurological diagnoses and longer duration of CVCs were associated with increased risk of CLABSI. The mean time to CLABSI was calculated as 8 ± 3 days (5-11 days). Duration of PICU stay (p = 0.0001) and duration of hospital stay (p = 0.002) were significantly higher for the CLABSI group, though organ dysfunction or mortality was not higher.Gram negative organisms (n = 17) caused 81% of the CLABSIs, followed by Candida species (n = 3, 14.3%) and gram positive organisms (n = 1, 4.7%). Pseudomonas species were the top isolates (n = 6, 28.5%) followed by Enterobacteriaceae -E.coli (n = 3 ; 17.6%) and Klebsiella (n = 3; 17.6%). 3 (17.6%) isolates of Acinetobacter species were isolated. Only 11.7% (n = 2) of the gram negative organisms were sensitive to cephalosporins. Carbapenem resistance was seen in 17.6% (n = 3). All Candida species were azole sensitive and the lone gram positive isolate was MRSA.Conclusion: CLABSIs were associated with prolonged PICU and hospital stay. Limiting the number of CVCs per patient and duration of catheterization to less than 8 days along with intense infection control measures are needed to reduce CLABSI rates in our PICU. The profile and drug resistance patterns reported here are very different from that quoted in the Western literature.