Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 1 ( January, 2020 ) > List of Articles

Original Article

Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream Infection in Liver Care Intensive Care Unit

Arvind Khodare, Pratibha Kale, Girisha Pindi, Lejo Joy, Vikas Khillan

Keywords : Bundle care, CLABSI, Healthcare-associated bloodstream infection, Infection control, Sepsis, Multidrug resistance

Citation Information : Khodare A, Kale P, Pindi G, Joy L, Khillan V. Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream Infection in Liver Care Intensive Care Unit. Indian J Crit Care Med 2020; 24 (1):17-22.

DOI: 10.5005/jp-journals-10071-23325

License: CC BY-NC 4.0

Published Online: 00-01-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aims and objectives: Central line-associated bloodstream infection (CLABSI) is among one of the preventable healthcare-associated infections (HAIs). The data for the CLABSI rate in liver care intensive care unit (LCICU) patients are scarce, so the present study was conducted to ascertain the CLABSI rate, the microbiological profile, and the impact of preventive measures for reduction of infection. Materials and methods: This is a prospective observational study done on LCICU patients during the period of January 2017–December 2018. We followed up patients on the central venous catheter for the development of CLABSI as a part of routine surveillance of HAIs. The impact of introduction and implementation of the CLABSI bundle to reduce the CLABSI rate was analyzed and the microbiological profile of infection was determined. Results: During the study period, the total number of patients admitted in LCICU were 1,336 (648 in 2017 and 688 in 2018) and a total of 995 central lines were inserted for various indications. A total of 57 patients were meeting the CLABSI criteria among 7,324 central line catheter days of surveillance. In year 2017, rate of CLABSI was 11.78/1,000 catheter days and after implementation of the bundle in 2018 the rate reduced to 3.99/1,000 catheter days. Gram-negative organisms (86%) predominated with Pseudomonas aeruginosa being the most common pathogen (19.3%). Out of 49 isolates of gram-negative bacilli (GNB), 40 (81.6%) were multidrug resistant (MDR) and 9 (18.4%) were pan-drug resistant. Conclusion: We found significant reduction in the CLABSI rate after implementation of the bundle of care. Gram-negative bacilli were the most common pathogen in our study and antimicrobial resistance was very high, which suggest hospital environment as a source of infection. Clinical significance: Knowledge of the microbiological profile and the preventive strategy of CLABSI is essential for prevention and timely initiation of the most appropriate anti-infective therapy, if it happens.


  1. Al-Abdullah N. Epidemiology of central line-associated bloodstream infection (CLABSI) among patients in the intensive care units (ICUs) at a teaching hospital in Saudi Arabia from year 2011-2016. J Intensive Crit Care 2018;4(1):2.
  2. Deepti, Sinha S, Sharma SK, Aggarwal P, Biswas A, Sood S, et al. Central Venous Catheter Related Bloodstream Infections in Medical Intensive Care Unit Patients in a Tertiary Referral Centre. Indian J Chest Dis Allied Sci 2014;56(2):85–91.
  3. Lin K-Y, Cheng A, Chang Y-C, Hung M-C, Wang J-T, Sheng W-H, et al. Central line-associated bloodstream infections among critically-ill patients in the era of bundle care. J Microbiol Immunol Infect 2017;50(3):339–348. DOI: 10.1016/j.jmii.2015.07.001.
  4. Bhatawadekar SM, Arunima, Lahiri KK. Bacterial profile of central line associated blood stream infections in I.C.U patients from tertiary care hospital. IP Int J Med Microbiol Trop Dis 2018;4(1):31–35. DOI: 10.18231/2455-6807.2018.0007.
  5. National Healthcare Safety Network, Centers for Disease Control and Prevention. The National Healthcare Safety Network (NHSN) manual: patient safety component protocol. 2018.
  6. Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y, et al. International nosocomial infection control consortium report, data summary of 50 countries for 2010-2015: device-associated module. Am J Infect Control 2016;44(12):1495–1504. DOI: 10.1016/j.ajic.2016.08.007.
  7. Mehta A, Rosenthal VD, Mehta Y, Chakravarthy M, Todi SK, Sen N, et al. Device-associated nosocomial infection rates in intensive care units of seven Indian cities. Findings of the international nosocomial infection control consortium (INICC). J Hosp Infect 2007;67(2):168–174. DOI: 10.1016/j.jhin.2007.07.008.
  8. Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012. Device-associated module. Am J Infect Control 2014;42(9):942–956. DOI: 10.1016/j.ajic.2014.05.029.
  9. Apisarnthanarak A, Thongphubeth K, Yuekyen C, Warren DK, Fraser VJ. Effectiveness of a catheter-associated bloodstream infection bundle in a Thai tertiary care center: A 3-year study. Am J Infect Control 2010;38(6):449–455. DOI: 10.1016/j.ajic.2009.08.017.
  10. Furuya EY, Dick A, Perencevich EN, Pogorzelska M, Goldmann D, Stone PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One. 2011;6(1):e15452. DOI: 10.1371/journal.pone.0015452.
  11. Institute for Healthcare Improvement. Implement the IHI Central Line Bundle. Last modified Aug 2, 2011. Accessed Oct 16, 2013.
  12. Mansur FJ, Barai L, Karim MM, Haq JA, Fatema K, Faruq MO. Intravascular catheter related infections and antimicrobial susceptibility pattern of isolated bacteria in a tertiary care hospital of Bangladesh. Indian J Med Microbiol 2014;32(1):68–71. DOI: 10.4103/0255-0857.124321.
  13. Khanna V, Mukhopadhayay C, Vandana KE, Verma M, Dabke P. Evaluation of central venous catheter associated blood stream infections: A microbiological observational study. J Pathog 2013;2013:936864. DOI: 10.1155/2013/936864.
  14. Marcos M, Soriano A, Inurrieta A, Martinez JA, Romero A, Cobos N, et al. Changing epidemiology of central venous catheter-related bloodstream infections: increasing prevalence of Gram-negative pathogens. J Antimicrob Chemother 2011;66(9):2119e25. DOI: 10.1093/jac/dkr231.
  15. Centres for Disease Control and Prevention. Vital signs: central line-associated blood stream infectionseUnited States 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep 2011;60(8):243e8.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.