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Table of Contents
ORIGINAL ARTICLE
Year : 2017  |  Volume : 5  |  Issue : 1  |  Page : 4-7

Central-line associated bloodstream infections at a tertiary care hospital


1 Junior Resident, Department of Medicine, C.U. Shah Medical College & Hospital, Surendranagar, Gujarat, India
2 Assistant Professor, Department of Medicine, C.U. Shah Medical College & Hospital, Surendranagar, Gujarat, India
3 Associate Professor, Department of Medicine, C.U. Shah Medical College & Hospital, Surendranagar, Gujarat, India

Date of Web Publication30-Aug-2018

Correspondence Address:
M M Sheta
Junior Resident, Department of Medicine, C.U. Shah Medical College & Hospital, Surendranagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240224

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  Abstract 


Introduction: The Central line associated bloodstream infections (CLABSI) are the bloodstream infections where central line was in situ for more than 48 hours from the time of event and the line was in place on the date of event or before that and are confirmed by lab investigation. CLABSI are becoming common hospital acquired infections in indoor patients.
Materials and Methods: This was a prospective one-year study to assess the occurrence of CLABSI at a tertiary care hospital in Gujarat. The study involved all hospitalized patients having a central line access during August 2015 to July 2016. CLABSI were identified according to the ‘Center for Disease Control and Prevention’ definitions. Microsoft excel was used for calculation of CLABSI rates and other statistical analysis.
Results: There was 3.69 per 1000 central line days of CLABSI. More CLABSI was seen with underlying medical co morbid conditions. In this study, there were five infections caused by ESBL producing organisms and one carbapenemase producing K. pneumoniae. This study shows multi drug resistant pathogens as causative agent of CLABSI. A higher rate of CLABSI in this study might be due to underlying co-morbid conditions.
Conclusion: CLABSI is a common entity especially in ICU setting. It is more commonly seen in patients with comorbid conditions. K. pneumoniae, S. aureus and CoNS are the common pathogens isolsted in CLABSI.

Keywords: CLABSI, Health care associated infection, Central-line, Infection


How to cite this article:
Chudasama C K, Sheta M M, Shah S I, Gediya U S. Central-line associated bloodstream infections at a tertiary care hospital. J Integr Health Sci 2017;5:4-7

How to cite this URL:
Chudasama C K, Sheta M M, Shah S I, Gediya U S. Central-line associated bloodstream infections at a tertiary care hospital. J Integr Health Sci [serial online] 2017 [cited 2021 Nov 30];5:4-7. Available from: https://www.jihs.in/text.asp?2017/5/1/4/240224




  Introduction Top


The central line associated bloodstream infections (CLABSI) are the bloodstream infections confirmed by laboratory where central line was in situ for more than 48 hours from the time of event and the line was in place on the date of event or before that.[1] The central line associated bloodstream infections (CLABSI) are now common hospital associated infections (HAIs) in hospitalized patients. In 2014, Centre for Disease Prevention and Control had estimated that the rate of CLABSI was three percent among patients staying in an ICU for more than two days.[2] There is also increase in the hospital costs due to high CLABSI infections.[3],[4],[5] Pinon M et al. showed a CLABSI incidence of 0.95.[6] This is a prospective study which was conducted for one year, to monitor hospitalized patients with central line for the occurrence of CLABSI and identify causative microorganism at a tertiary care hospital in Gujarat. The study involved all hospitalized patients having a central line access during August 2015 to July 2016.


  Methodology Top


This prospective observational study was done among hospitalized patients with a central line access during August 2015 to July 2016 at a tertiary care hospital. All patients admitted in ICU with central line inserted were included. The patients were enrolled from August 2015 to July 2016. Total 369 hospitalized patients with central line who fulfilled the inclusion criteria were enrolled in the study during the study period.

Diagnosis of CLABSI was made based on positive blood culture fro central line and peripheral vein.[1] Blood was inoculated in brain heart infusion broth. Positive cultures were isolated and identified manually as per standard guidelines. [7] The data was collected daily in a standardized predesigned study format. CLABSI rate was measured and compared with the study variables using Microsoft excel.


  Results Top


Total 369 patients with central line in situ that fulfilled inclusion criteria of study were included. There were 16 female and 11 male patients. The mean age of patients was 37 years. The comorbid conditions of the patients included in the study were: medical (n = 198), cancer (n =132), surgical (n = 33) and other (n = 6).
Table 1: Number of CLABSI cases in different groups

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Median catheter insertion time during hospital admission was 3.5 days with total 7312 catheter observation-days. During the study period, there were total 27 CLABSI episodes. The incidence of CLABSI was 3.69/1000 central line-days. Among these, 9 catheters were inserted in jugular vein and 18 were peripherally inserted. Maximum CLABSI were observed in patients with a medical comorbid condition (i.e., cardiac diseases, metabolic, respiratory, hypertension, neurological or renal diseases). More CLABSI was noted in patients within the respiratory group compared to the other comorbid conditions. All CLABSI were observed in patients who were in intensive care unit for some time during their hospital stay. There were five infections, that are caused by ESBL producing organisms 4 - K. pneumonia and 1 - E. coli and 1 infection was by carbapenemase producing . The CLABSI caused by Candida were sensitive to fluconazole and most of other anti-fungal agent [Table 2][Table 3].
Table 2: Organisms isolated in CLABSI.

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Table 3: ESBL and carbapenemase producing organisms isolated in CLABSI.

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  Discussion Top


This prospective study was done to assess the occurrence of CLABSI among hospitalized patients of tertiary care hospital in a one-year study period. In our study CLABSI was 3.69/1000 central line-days. Study published in 2006 by Peter pronovost et al.[8] had shown CLABSI of 2.7/1000 central line days in Michigan, that is less than our study results. Similar findings were also reported in a multi centric study done in 2009 from USA.[9] CLABSI rate of 4.0 was reported by Soraya Cherifi et al. in 2013 from Belgium.[10] We observed that underlying medical conditions of patients was one of the important risk factors in occurrence of CLABSI. However, there are very few studies available that correlate CLABSI with comorbid clinical condition of patients. Most studies focused more on intensive care and oncological patients.[6],[11],[12],[13],[14],[15] The common microorganism isolated with CLABSI are Staphylococci (S. aureus, CoNS), Enterobacteriaceae (K. pneumonie, E. coli) and Candida. Enterobacteriaceae is an important cause of severe CLABSI infections. These enterobacteriaceae are of concern due to high rise of carbapenem, ESBL and multi drug resistance.[16] Montagnani C et al. had shown that gram negative resistance rate to 3rd generation cephalosporins is 30 - 56%, carbapenem resistant Klebsiella 34% in invasive infections from Italy.[17] In our study, there were five infections, that are caused by ESBL producing organisms 4 - K. pneumonia and 1 - E. coli and 1 infection was by carbapenemase producing K. pneumoniae. The CLABSI caused by Candida were sensitive to fluconazole and most of other anti-fungal agent tested.


  Conclusion Top


CLABSI is a common entity especially in ICU setting. It is more commonly seen in patients with comorbid conditions. K. pneumoniae, S. aureus and CoNS are the common pathogens isolsted in CLABSI.



 
  References Top

1.
Centers of Disease Control and Prevention. Bloodstream Infection Event (Central Line- associated Bloodstream Infection and Non-central line-associated Bloodstream Infection). 2015. www.cdc.gov/nhsn/PDFs/pscManual/4PSC_CLABScurrent.pdf. Accessed 5 Jan 2017.  Back to cited text no. 1
    
2.
Centre for Disease Control and Prevention. Annual epidemiological report 2014- Antimicrobial resistance and healthcare associated infections. 2014. http://ecdc.europa.eu/en/publications/surveillance_reports/annual_epidemiological_report/Pages/epi_index.aspx. Accessed 5 Jan 2017.  Back to cited text no. 2
    
3.
Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care–associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA internal medicine. 2013 Dec 9;173(22):2039-46.  Back to cited text no. 3
    
4.
Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics. 2014 Jun; 133(6):1525–32.   Back to cited text no. 4
    
5.
Wilson MZ, Rafferty C, Deeter D, Comito MA, Hollenbeak CS. Attributable costs of central line-associated bloodstream infections in a pediatric hematology/oncology population. American journal of infection control. 2014 Nov 30;42(11):1157-60.  Back to cited text no. 5
    
6.
Pinon M, Bezzio S, Tovo PA, Fagioli F, Farinasso L, Calabrese R, Marengo M, Giacchino M. A prospective 7-year survey on central venous catheter-related complications at a single pediatric hospital. European journal of pediatrics. 2009 Dec 1;168(12):1505-12.  Back to cited text no. 6
    
7.
Koneman EW, Allen SD, Janda WM et al. Color atlas and textbook of diagnostic microbiology. 6th ed. Lippincott Williams and Wikins;2006.  Back to cited text no. 7
    
8.
Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J. An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine. 2006 Dec 28;355(26):2725-32.  Back to cited text no. 8
    
9.
Pronovost PJ, Goeschel CA, Colantuoni E, Watson S, Lubomski LH, Berenholtz SM, Thompson DA, Sinopoli DJ, Cosgrove S, Sexton JB, Marsteller JA. Sustaining reductions in catheter related bloodstream infections in Michigan intensive care units: observational study. Bmj. 2010 Feb 4;340:c309.  Back to cited text no. 9
    
10.
Cherifi S, Gerard M, Arias S, Byl B. A multicenter quasi-experimental study: impact of a central line infection control program using auditing and performance feedback in five Belgian intensive care units. Antimicrobial resistance and infection control. 2013 Dec 5;2(1):33.  Back to cited text no. 10
    
11.
Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, Balkhy H, Hu B, Alvarez-Moreno C, Medeiros EA, Apisarnthanarak A. International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. American journal of infection control. 2014 Sep 30;42(9):942-56.  Back to cited text no. 11
    
12.
Patrick SW, Kawai AT, Kleinman K, Jin R, Vaz L, Gay C, Kassler W, Goldmann D, Lee GM. Health care-associated infections among critically ill children in the US, 2007-2012. Pediatrics. 2014 Oct 1;134(4):705-12.  Back to cited text no. 12
    
13.
Bion J, Richardson A, Hibbert P, Beer J, Abrusci T, McCutcheon M, Cassidy J, Eddleston J, Gunning K, Bellingan G, Patten M. ‘Matching Michigan’: a 2-year stepped interventional programme to minimize central venous catheter-blood stream infections in intensive care units in England. BMJ QualSaf. 2013; 22:110–23.  Back to cited text no. 13
    
14.
Niedner MF, Huskins WC, Colantuoni E, Muschelli J, Harris JM, Rice TB, Brilli RJ, Miller MR. Epidemiology of central line-associated bloodstream infections in the pediatric intensive care unit. Infection Control & Hospital Epidemiology. 2011 Dec 1;32(12):1200-8.  Back to cited text no. 14
    
15.
Coco I, Casale F, Indolfi P. Infections from CVC in the pediatric neoplastic patient. Single institution experience. Minerva pediatrica. 2012 Aug;64(4):385-94.  Back to cited text no. 15
    
16.
Logan LK. Carbapenem-resistant enterobacteriaceae: an emerging problem in children. Clinical infectious diseases. 2012; 55:852-9.  Back to cited text no. 16
    
17.
Montagnani C, Prato M, Scolfaro C, Colombo S, Esposito S, Tagliabue C, Lo Vecchio A, Bruzzese E, Loy A, Cursi L, Vuerich M. Carbapenem-resistant Enterobacteriaceae Infections in Children. The Pediatric infectious disease journal. 2016 Aug 1;35(8):862-8.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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