Prevalence of Catheter-related Bloodstream Infection and Distribution of Multidrug Resistance Microorganisms among the Hospitalized Patients

Oltiana Petri; Klotilda Vrenjo; Alda Angjeli; Erjona Abazaj; Blerta Kika; Andi Koraqi; Albana Daka

doi:10.3889/oamjms.2022.7464

Authors

Oltiana Petri Department of Microbiology, American Hospital, Tirana, Albania; Department of Education and Health, Sports University, Tirana, Albania; Department of Microbiology, University of Medicine, Tirana, Albania
Klotilda Vrenjo Department of Education and Health, Sports University, Tirana, Albania
Alda Angjeli Department of Microbiology, American Hospital, Tirana, Albania
Erjona Abazaj National References Laboratory, Institute of Public Health, Tirana, Albania https://orcid.org/0000-0003-2386-4605
Blerta Kika National References Laboratory, Institute of Public Health, Tirana, Albania
Andi Koraqi Department of Microbiology, University of Medicine, Tirana, Albania
Albana Daka Department of Microbiology, American Hospital, Tirana, Albania

DOI:

https://doi.org/10.3889/oamjms.2022.7464

Keywords:

Central venous catheter-related bloodstream infection, Hospitalized patients, Multidrug resistant

Abstract

BACKGROUND: Central venous catheter (VC)-related bloodstream infection (CRBSI) is associated with high rates of morbidity and mortality in critically ill patients over the world.

AIM: The aims study is to evaluate the prevalence of CRBSI and to identify some of the factors.

METHODS: This was a retrospective, observational study carried out in the tertiary care hospital “Mother Theresa,” Tirana and American Hospital, Tirana, over a period of 3 years from January 2016 to December 2018. Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients’ unique medical record numbers. A total of 170 patients with indwelling VC were included in the study. The catheters were cultured using the standard procedure. Statistical analysis version SPSS-20 software was used for calculation of data.

RESULTS: Overall 170 patients analyzed in this study, the prevalence of CRBSI results 58.8%. The positivity from the University Hospital Center (UHC) “Mother Theresa” resulted 65.1% (82/126 cases) and the positivity from American Hospitals (AH) resulted 40.91% (18/44 cases). Patients from UHC Mother Theresa were (odds ratio) 2.69 times higher in risk for CRBSI compared to patients from AH, for confidence interval 95% (1.33–5.44) p value resulted to be with strong association = 0.005. The average age resulted 59.68 ± 14.26, with minimum age 9 years old and maximum age 83 years old. The most infected age groups resulted patients with age 61–70 years old. Central VC had a higher positivity compared to other catheters types. Regarding the spectrum of bacteria implicated in CRBSI infections, Gram positive bacteria (67%) were the most predominant compared to Gram-negative bacteria (33%), but regarding the antimicrobial resistance, the Gram-negative bacteria resulted majority of multidrug resistance.

CONCLUSION: The overall prevalence of CRBSI was 58.8%. Patients from Mother Theresa Hospital have the highest prevalence compared to patients of American Hospital. Men patients were the most predominant sex; age groups 61–70 years old presented the highest positive cases with CRBSI. Staphylococcus spp., Acinetobacter spp., Proteus spp., etc., were the most common isolate. We found antimicrobial resistance almost in all bacteria, but Gram-negative bacteria resulted majority of multidrug resistance.

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References

Hoefel A. Biofilm Formation in Central Venous Catheters a Prospective Study Performed with Catheters from Organ Donors, Diploma Thesis; 2016.

Ruesch S, Walder B, Tramèr MR. Complications of central venous catheters: Internal jugular versus subclavian access--a systematic review. Crit Care Med. 2002;30(2):454-60. https://doi.org/10.1097/00003246-200202000-00031 PMid:11889329 DOI: https://doi.org/10.1097/00003246-200202000-00031

Yousif A, Jamal MA, Raad I. Biofilm-based central line-associated bloodstream infections. Adv Exp Med Biol. 2015;830:157-79. https://doi.org/10.1007/978-3-319-11038-7_10 PMid:25366227 DOI: https://doi.org/10.1007/978-3-319-11038-7_10

Gow KW, Hickman RO. AAP experience. National Conference and Exhibit. What’s in a Name. San Diego, USA: The History of Central Venous Catheters; 2014.

Marcos M, Soriano A, Iñurrieta A, Martínez JA, Romero A, Cobos N, et al. Changing epidemiology of central venous catheter-related bloodstream infections: Increasing prevalence of Gram-negative pathogens. J Antimicrob Chemother. 2011;66(9):2119-25. https://doi.org/10.1093/jac/dkr231 PMid:21665905 DOI: https://doi.org/10.1093/jac/dkr231

Raad I, Hanna H, Maki D. Intravascular catheter-related infections: Advances in diagnosis, prevention, and management. Lancet Infect Dis. 2007;7(10):645-57. https://doi.org/10.1016/ S1473-3099(07)70235-9 PMid:17897607 DOI: https://doi.org/10.1016/S1473-3099(07)70235-9

Mermel LA, Allon M, Bouza E, Craven DE, Flynn P, O‘Grady NP, et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the infectious Diseases Society of America. Clin Infect Dis. 2009;49(1):1-45. PMid:19489710 DOI: https://doi.org/10.1086/599376

Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: A systematic review of 200 published prospective studies. Mayo Clin Proc. 2006;81(9):1159-71. https://doi.org/10.4065/81.9.1159 PMid:16970212 DOI: https://doi.org/10.4065/81.9.1159

Sreeramoju PV, Tolentino J, Garcia-Houchins S, Weber SG. Predictive factors for the development of central line-associated bloodstream infection due to gram-negative bacteria in intensive care unit patients after surgery. Infect Control Hosp Epidemiol. 2008;29(1):51-6. https://doi.org/10.1086/524334 PMid:18171187 DOI: https://doi.org/10.1086/524334

Patil HV, Patil VC, Ramteerthkar MN, Kulkarni RD. Central venous catheter related bloodstream infections in the intensive care unit. Indian J Crit Care Med. 2011;15(4): 213-23. https://doi.org/10.4103/0972-5229.92074 PMid:22346032 DOI: https://doi.org/10.4103/0972-5229.92074

Pronovost P, Needham D, Berenholtz S, Sinopoli D, Chu H, Cosgrove S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med. 2006;355(26):2725-32. https://doi.org/10.1056/NEJMoa061115 PMid:17192537 DOI: https://doi.org/10.1056/NEJMoa061115

Richet H, Hubert B, Nitemberg G, Andremont A, Buu-Hoi A, Ourbak P, et al. Prospective multicenter study of vascular-catheter-related complications and risk factors for positive central catheter cultures in intensive care unit patients. J Clin Microbial. 1990;28(11):2520-5. https://doi.org/10.1128/jcm.28.11.2520-2525.1990 Mid:2254429 DOI: https://doi.org/10.1128/jcm.28.11.2520-2525.1990

Frasca D, Dahyot-Fizelier C, Mimoz O. Prevention of central venous catheter-related infection in the intensive care unit. Crit Care. 2010;14(2):212. https://doi.org/10.1186/cc8853 PMid:20236456 DOI: https://doi.org/10.1186/cc8853

Nidhi N, Suchandra G, Iva C, Vijay K. Prevalence of central line associated blood stream infection (CRBSI) and catheter colonization in ICU settings of a tertiary care hospital in sub- Himalayan region. Trop J Pathol Microbiol. 2019;5(10):815-21. DOI: https://doi.org/10.17511/jopm.2019.i10.10

Curtis RL. Catheter-related bloodstream infection in the intensive care unit. J Iran Chem Soc. 2009;10(2):102-8. DOI: https://doi.org/10.1177/175114370901000208

Gahlot R, Nigam C, Kumar V, Gupta M. Catheter related bloodstream infections in ICU: A study from North India. Int J Infection Control. 2013;9(2):4. DOI: https://doi.org/10.3396/ijic.v9i2.013.13

Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Epidemiology and outcome of Klebsiella species bloodstream infection: A population-based study. Mayo Clin Proc. 2010;85:139-44. https://doi.org/10.4065/mcp.2009.0410 PMid:20118389 DOI: https://doi.org/10.4065/mcp.2009.0410

Al-Hasan MN, Lahr BD, Eckel-Passow JE, Baddour LM. Temporal trends in Enterobacter species bloodstream infection: A population-based study from 1998-2007. Clin Microbiol Infect. 2011;17:539-45. https://doi.org/10.1111/j.1469-0691.2010.03277.x PMid:20518795 DOI: https://doi.org/10.1111/j.1469-0691.2010.03277.x

Garibaldi RA, Burke JP, Dickman ML, Smith CB. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med. 1974;291(5):215-9. https://doi.org/10.1056/NEJM197408012910501 PMid:4834750 DOI: https://doi.org/10.1056/NEJM197408012910501

Gokula RR, Hickner JA, Smith MA. Inappropriate use of urinary catheters in elderly patients at a midwestern community teaching hospital. Am J Infect Control. 2004;32(4):196-9. https://doi.org/10.1016/j.ajic.2003.08.007 PMid:15175612 DOI: https://doi.org/10.1016/j.ajic.2003.08.007

Cohen B, Choi YJ, Hyman S, Furuya EY, Neidell M, Larson E. Gender differences in risk of bloodstream and surgical site infections. J Gen Intern Med. 2013;28(10):1318-25. https://doi.org/10.1007/s11606-013-2421-5 PMid:23605308 DOI: https://doi.org/10.1007/s11606-013-2421-5

Hoen B, Paul-Dauphin A, Hestin D, Kessler M. EPIBACDIAL: A multicenter prospective study of risk factors for bacteremia in chronic hemodialysis patients. J Am Soc Nephrol. 1998;9(5):869-76. https://doi.org/10.1681/ASN.V95869 PMid:9596085 DOI: https://doi.org/10.1681/ASN.V95869

Tokars JI, Light P, Anderson J, Miller ER, Parrish J, Armistead N, et al. A prospective study of vascular access infections at seven outpatient hemodialysis centers. Am J Kidney Dis. 2001;37(6):1232-40. https://doi.org/10.1053/ajkd.2001.24527 PMid:11382693 DOI: https://doi.org/10.1053/ajkd.2001.24527

Taylor G, Gravel D, Johnston L, Embil J, Holton D, Paton S, et al. Incidence of bloodstream infection in multicenter inception cohorts of hemodialysis patients. Am J Infect Control. 2004;32(3):155-60. https://doi.org/10.1016/j.ajic.2003.05.007 Mid:15153927 DOI: https://doi.org/10.1016/j.ajic.2003.05.007

Sedlacek M, Gemery JM, Cheung AL, Bayer AS, Remillard BD. Aspirin treatment is associated with a significantly decreased risk of Staphylococcus aureus bacteremia in hemodialysis patients with tunneled catheters. Am J Kidney Dis. 2007;49(3):401-8. https://doi.org/10.1053/j.ajkd.2006.12.014 Mid:17336701 DOI: https://doi.org/10.1053/j.ajkd.2006.12.014

Powe NR, Jaar B, Furth SL, Hermann J, Briggs W. Septicemia in dialysis patients: Incidence, risk factors, and prognosis. Kidney Int. 1999;55:1081-90. https://doi.org/10.1046/j.1523-1755.1999.0550031081.x PMid:10027947 DOI: https://doi.org/10.1046/j.1523-1755.1999.0550031081.x

Murea M, James KM, Russell GB, Byrum GV 3rd, Yates JE, Tuttle NS, et al. Risk of catheter-related bloodstream infection in elderly patients on hemodialysis. Clin J Am Soc Nephrol. 2014;9(4):764-70. https://doi.org/10.2215/CJN.07710713 id:24651074 DOI: https://doi.org/10.2215/CJN.07710713

Culverwell E. Central Venous Access Devices. Resource Book. 1st ed. Professional Development Unit; 2011.

Orsini J, Mainardi C, Muzylo E, Karki N, Cohen N, Sakoulas G. Microbiological profile of organisms causing bloodstream infection in critically ill patients. J Clin Med Res. 2012;4(6):371-7. https://doi.org/10.4021/jocmr1099w PMid:23226169 DOI: https://doi.org/10.4021/jocmr1099w

Hasan S, Imtiaz F, Khan MA, Iqbal A. Blood stream infections and their sensitivity pattern in a tertiary care hospital. Ther Adv Infect Dis. 2015;2(52):2321-3485.

Gaynes R. Definitions and Epidemiology of Nosocomial Intravascular Catheter-related (Primary) Bloodstream Infections; 2009.