INTRODUCTION: Central venous catheter (CVC) placement is an unavoidable part
of the everyday medical practice. At the same time CVC application is
associated with high risk of development of central line-associated
bloodstream infections (CLABSIs). These infections are cause of icreased
morbidity and mortality rates as well as higer costs of the inpatient
treatment2. Risk factors for onset of CLABSIs include duration of
catheterization, length of hospital stay before catheterization, anatomic
site of placement, CVC placement at the intensive care units (ICU),
parenteral nutrition (PN) and ommisions diring CVC placement, use and care.
CLABSI incidence rates vary depending on distribution of different risk
factors associated with CVC and patient him/herself. The most significant
causative organisms of CLABSIs are coagulase-negative Staphylococcocae,
Staphylococcus aureus (S.aures), Enterococcus spp. i Candida spp. CLABSIs
prevention measures include compliance with the rules of the aseptic
technique upon placement, use and care of CVCs, which, based on the study
results, may enable prevention of 65% to 70% of cases of CLABSIs. METHODS: A
prospective cohort study included 200 patients hospitalized at the intensive
care and therapy units of the CCS Clinic of Digestive Surgery in the period
November 30th, 2006-November 31st, 2007 in whom CVC was placed for more than
48 hours. All the data necessary for the study were obtained based on the
review of the case histories and they were recorded into the individual
questionnaires for each patient. The questionnarire included patient
information (age, gender, underlying disease, presence of other infections),
information related to diagnostic and therapeutic procedures to which the
patient was exposed. The incidence of CRBSIs in ICU patients, Institute of
Digestive Diseases, CCS over the study period was 10.08 per 1,000
catheter-days. During the study CLABSI more often present in the females.
Additionally, application of albumin and amino acids, ICU stay longer that 7
days and CVC application longer than 15 days, significantly more often
present in patients with CRBSIs than in the group of patients without CRBSIs.
Independent factors for development of CRBSI are gender, administration of
albumin and amino acids. The most common microorganisms isolated from
hemocultures and CVC were S. aureus and Klebsiella spp., with 31,8% of
isolates each. Statistically significant difference was evidenced in
frequency of resistance of S. aureus isolates to methicillin in the group of
patients with CRBSI in comparison to the group of patients without CLABSIs.
CLABSIs prevention measurs include compliance with the rules of the aseptic
technique upon placement, use and care of CVCs.
Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India
