Incidence, microbial profile and antimicrobial resistance trends of CLABSI in adult ICUs: a longitudinal prospective study

Gargee  Anand; Asim  Sarfraz; Bhaskar  Thakuria; Prathyusha  Kokkayil; Binod Kumar  Pati

doi:10.18502/ijm.v18i1.20905

Gargee Anand Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
Asim Sarfraz Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
Bhaskar Thakuria Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
Prathyusha Kokkayil Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India
Binod Kumar Pati Department of Microbiology, All India Institute of Medical Sciences, Patna, Bihar, India

DOI: https://doi.org/10.18502/ijm.v18i1.20905

Keywords: Healthcare associated infections; Catheter-associated infections; Bloodstream infection; Central venous cathe- ter; Antimicrobial resistance

Abstract

Background and Objectives: Central line-associated bloodstream infections (CLABSIs) remain a major cause of health- care-associated mortality, prolonged hospitalization, and increased healthcare costs, especially in resource-poor settings where surveillance data are scarce. This study aimed to determine CLABSI incidence, risk factors, causative organisms, and antimicrobial resistance (AMR) patterns across adult intensive care units (ICUs).

Materials and Methods: A prospective longitudinal study was conducted amongst 200 adult ICU patients with central line (CL) in-situ for >2 calendar days. CLABSI surveillance followed definitions by The Centers for Disease Control and Prevention, National Healthcare Safety Network. Microbiological identification and antimicrobial susceptibility testing were performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines.

Results: The overall CLABSI incidence was 19.25/1,000 catheter days. CLABSI patients demonstrated significantly ex- tended hospitalization (20.22 vs 9.09 days, p<0.001) and CL duration (16.17 vs 7.85 days, p<0.001). Femoral lines had the highest infection rate (42.85%). The median time from CL insertion to the onset of CLABSI was 7.5 days. Gram-negative organisms predominated (75%), with Acinetobacter species being most frequent (36.1%), followed by Candida species (22.23%). Comorbidities such as hypertension, type 2 diabetes mellitus, tuberculosis, and drug abuse showed no significant association with CLABSI. Antimicrobial resistance (AMR) was extensive; all isolates were resistant to most antibiotic class- es, including penicillins, cephalosporins, and carbapenems. In contrast, colistin retained 100% susceptibility. CLABSI was associated with significantly higher mortality (69.4% vs. 47%; p = 0.014) and a lower rate of discharge/transfer to a healthy setting (p = 0.0112) compared to non-CLABSI patients.

Conclusion: The study demonstrates high CLABSI incidence and alarming levels of AMR, underscoring the urgent need for strengthening infection prevention practices and antimicrobial stewardship in ICUs.