Surveillance of central-line-associated blood stream infections (CLABSI) in intensive care units of a tertiary care center in Western India

TL;DR

This study tracks bloodstream infections from central lines in Indian hospital ICUs, finding high rates linked to drug-resistant bacteria.

Contribution

The study provides current CLABSI incidence data and antimicrobial resistance patterns specific to a tertiary care center in Western India.

Findings

CLABSI incidence was 15.6 per 1,000 central line days, highest in neuro-ICU at 21.6 per 1,000.

Klebsiella pneumoniae and Acinetobacter baumannii were the most common pathogens, with high carbapenem resistance.

49.2% mortality rate was observed among CLABSI cases, with most patients over 60 years old.

Abstract

Central-line—associated bloodstream infection (CLABSI) is the most prevalent type of healthcare-associated infection (HAI). It ranks as one of the primary contributors to both morbidity and mortality in hospitals globally. The occurrence of CLABSI is influenced by a variety of risk factors. It is essential to collect precise data on the trends of incidence rates, causes, and antimicrobial resistance patterns of central line-associated bloodstream infections (CLABSIs)in the setting to formulate empirical treatment regimens and emphasize robust infection control policy.

To study the prevalence, etiology and antimicrobial susceptibility of CLABSI in adult medical and surgical ICUs in a tertiary care private hospital in Jaipur, India.

This prospective observational study was conducted at the medical and surgical intensive care units for adults of Mahatma Gandhi medical college and hospital, Jaipur, Rajasthan, India from January 2023 to December 2023. The CLABSI event was identified according to the Centers for Disease Control (CDC) definition as part of the routine surveillance of HAIs. The incidence rates of CLABSI (per 1.000 central line days) were calculated. Identification and antibiotic susceptibility were determined using an automated blood-culture system.

During the study period, 59 patients experienced a single episode of CLABSI, with a mean prevalence rate of 15.6 per 1,000 central line days; the maximum rate was found in the neuro-ICU (21.6 per 1,000 central line days). The clinic-demographic profile showed 2.1–to-1 male:female ratio with maximum occurrence of cases in patients over 60 years of age (25/59; 42.4%). The most common site of CL insertion was the jugular vein (97%). The majority of cases (88.1%) occurred in patients with prolonged ICU stays exceeding 10 days with an overall mortality rate of 49.2% (29/59). The most common causative micro-organism was Klebsiella pneumoniae (17/59; 29%), followed by Acinetobacter baumannii (14/59; 24%). 83% (33/40) of Gram-negative isolates were resistant to carbapenem, an no isolates were resistant to colistin.

The study revealed a disproportionately high incidence of CLABSI when compared with both developed and developing countries, with multi-drug-resistant Gram-negative bacteria being the predominant causative agents. Continuous surveillance, supported by infection control practices, e.g., hand hygiene and bundle compliance audits along with stringent antimicrobial stewardship, is vital in mitigating CLABSI.

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