A Cross-Sectional Study of Catheter-Related Bloodstream Infections in a Tertiary Care Hospital in India

Catheter-related bloodstream infections (CRBSI) are commonly seen in critically ill patients with indwelling central venous catheters. To address CRBSI, one must know the causative microorganisms and their antimicrobial susceptibility profiles. This study aimed to identify the microbes that cause CRBSI and their antimicrobial susceptibility patterns.

This cross-sectional study was conducted at the Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India, between March 2022 and February 2023. Adult patients in the ICU with a central line and suspected CRBSI during the study period were included. Those with a bloodstream infection (BSI) prior to ICU admission were excluded. Two blood samples from peripheral veins and the lumen of a central venous catheter were collected for culture and sensitivity of the microorganisms. Chocolate agar, 5% sheep blood agar, and MacConkey agar served to culture pathogenic microbes. The VITEK 2 system (bioMérieux, Marcy-l'Étoile, France) was used to determine the pathogenic strains and perform antimicrobial susceptibility testing (AST). We used the R software (R Foundation for Statistical Computing, Vienna, Austria, version 4.4.3) to analyze the data.

Among the 84 participants, CRBSI was found in 36 (42.8%) patients. Their median age was 53.5 (45.8-65.0) years. Of those 36 patients, 25 (69.4%) were males. The most common cannulation site was the femoral vein (14, 38.9%), followed by the internal jugular vein (12, 33.3%) and the subclavian vein (10, 27.8%). The median durations of ICU stay and indwelling catheters were 23.0 (13.8-41.3) days and 16.0 (8.8-30.0) days, respectively. The most common microorganism causing CRBSI was Klebsiella pneumoniae (8, 22.2%), followed by Acinetobacter baumannii (5, 13.9%), Burkholderia cepacia (3, 8.3%), Candida tropicalis (3, 8.3%), Escherichia coli (3, 8.3%), Pseudomonas aeruginosa (3, 8.3%), and Staphylococcus aureus (3, 8.3%). Klebsiella pneumoniae and Escherichia coli specimens were highly sensitive to tigecycline. Acinetobacter baumannii, Burkholderia cepacia, and Pseudomonas aeruginosa specimens were mainly sensitive to colistin, tigecycline, and ertapenem. Staphylococcus aureus isolates were sensitive to vancomycin, linezolid, and daptomycin. Candida tropicalis isolates were 100% sensitive to caspofungin and micafungin.

CRBSI among our study participants was mainly caused by Klebsiella pneumoniae, Acinetobacter baumannii, Burkholderia cepacia, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Candida tropicalis. The Gram-negative bacteria were highly susceptible to tigecycline. Staphylococcus aureus specimens demonstrated their sensitivity to vancomycin, linezolid, and daptomycin. The Candida tropicalis specimens were sensitive to echinocandins. We suggest further studies with more participants to investigate the pathogens causing CRBSI and their AST patterns.