Intravascular catheter-related infections in an Indian tertiary care hospital

Abstract

Introduction: This study had two objectives: 1) to determine the clinical and microbiological profiles of patients developing intravascular catheter-related local (localized catheter colonization and exit site) and systemic infections and their predisposing factors; 2) to study the antibiotic sensitivity patterns of the organisms isolated.

Methodology: This case-control study was conducted over 19 months involving 232 patients at a tertiary care hospital. Non-tunneled central venous catheters and midline catheters were the two types studied. Catheter tips were processed using Maki's roll plate and endoluminal flush techniques. Blood cultures were drawn under strict aseptic precautions and processed by the BacT ALERT system. A "case" was any patient with proven localized catheter colonization, exit site infection or blood-stream infection and a "control" was any patient from whom the intravascular catheter yielded no organism in semi-quantitative cultures.

Results and Conclusions: The incidence of catheter-related blood-stream infections (CRBSI) in our institute was 8.75 per 1,000 catheter days. The commonest organisms causing local infections were coagulase-negative Staphylococci, and those causing CRBSI were Staphylococcus aureus. Multidrug-resistant organisms accounted for 30.2% of the infections. Risk factors for development of catheter-related infections included an immune compromised state, duration of the catheter in situ, femoral venous cannulation, and triple lumen catheters. Choice of venous cannulation to minimize the risk of catheter-related infection in ascending order for risk of infection is the subclavian vein, jugular vein, basilic vein and then the femoral vein. There was no role for empirical antibiotic therapy to prevent intravascular catheter-related local or systemic infections.