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Published on: July 13, 2019
Incidence, Microbiological Profile, and Impact of Preventive Measures on Central Line-associated Bloodstream
Arvind Khodare1, Pratibha Kale1, Girisha Pindi1
1Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India.
Insights
Implementing a care bundle significantly reduced central line-associated bloodstream infections (CLABSI) in liver care intensive care units. This initiative lowered infection rates and highlighted the prevalence of multidrug-resistant Gram-negative bacteria.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Central line-associated bloodstream infection (CLABSI) is a critical healthcare-associated infection (HAI) with significant morbidity and mortality.
- Data on CLABSI rates in liver care intensive care units (LCICUs) are limited, necessitating further investigation.
- Preventable HAIs like CLABSI require targeted surveillance and intervention strategies.
Purpose of the Study:
- To determine the incidence rate of CLABSI in an LCICU.
- To identify the prevalent microbiological profile of CLABSI in this patient population.
- To evaluate the effectiveness of a CLABSI prevention bundle in reducing infection rates.
Main Methods:
- A prospective observational study was conducted in an LCICU from January 2017 to December 2018.
- Central venous catheter surveillance was performed to identify CLABSI cases.
- The impact of a CLABSI bundle intervention on infection rates and the microbiological characteristics of infections were analyzed.
Main Results:
- The CLABSI rate decreased from 11.78 per 1,000 catheter days in 2017 to 3.99 per 1,000 catheter days in 2018 after bundle implementation.
- Gram-negative organisms accounted for 86% of infections, with *Pseudomonas aeruginosa* being the most common pathogen (19.3%).
- A high prevalence of antimicrobial resistance was observed, with 81.6% of Gram-negative bacilli isolates being multidrug-resistant (MDR) and 18.4% pan-drug resistant (PDR).
Conclusions:
- The implementation of a care bundle led to a significant reduction in CLABSI rates within the LCICU.
- Gram-negative bacilli, often multidrug-resistant, are the predominant pathogens, suggesting the hospital environment as a potential source.
- Understanding the microbiological landscape and implementing preventive strategies are crucial for managing and preventing CLABSI.
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.
How To Cite This Article:
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.
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