Epidemiology of Blood Stream Infections at a Level-1 Trauma Care Center of India

ABSTRACT

Purpose: Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices.

Materials and Methods: A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome.

Results: A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens.

Conclusions: Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.

Key words:

Central line associated-BSI - ICUs - nosocomial blood stream infections - secondary bacteremia - trauma

Publication History

Article published online:
19 April 2020

• REFERENCES

• 1 Velasco E, Byington R, Martins CS, Schirmer M, Dias LC, Gonçalves VM. Bloodstream infection surveillance in a cancer centre: A prospective look at clinical microbiology aspects Clin Microbiol Infect 2004;10:542-9.
• 2 Reimer LG, Wilson ML, Weinstein MP. Update on detection of bacteremia and fungemia. Clin Microbiol Rev 1997;10:444-65.
• 3 Taylor G, Buchanan-Chell M, Kirkland T, Mckenzie M, Wiens R. Long term trends in the occurrence of nosocomial blood stream infection. Can J Infect Dis 2000;11:29-33.
• 4 Centers for Disease Control and Prevention (CDC). Vital signs: Central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Weekly Rep 2011;60:243-8. Available from: http://www.cdc.gov/mmwr [Last accessed on 2013 Apr 20].
• 5 Weinstein MP, Towns ML, Quartey SM, Mirrett S, Reimer LG, Parmigiani G, et al. The clinical significance of positive blood cultures in the 1990s: A prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997;24:584-602.
• 6 Passerini R, Ghezzi T, Sandri M, Radice D, Biffi R. Ten-year surveillance of nosocomial bloodstream infections: Trends of aetiology and antimicrobial resistance in comprehensive cancer centre. Ecancermedicalscience 2011;5:191.
• 7 Raveh D, Rudensky B, Schlesinger Y, Benenson S, Yinnon AM. Susceptibility trends in bacteraemias: Analyses of 7544 patient-unique bacteraemic episodes spanning 11 years (1999-2000). J Hosp Infect 2003;55:196-203.
• 8 Behera B, Mathur P. High levels of antimicrobial resistance at a tertiary trauma care centre of India. Indian J Med Res 2011;133:343-5.
• 9 CDC. National Healthcare Safety Network. Device Associated Infections Module. Protocols and Instructions. 2010. Available from www.cdc.gov/nhsn/psc-da.html. http://www.cdc.gov/nhsn/library.html [Last accessed on 2013 Apr 14].
• 10 Garner JS, Jarvis WR, Emori TG, Horan TC, Hughes JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128-40. Available from www.ncbi.nlm.nih.gov/pubmed/2841893 [Last accessed on 2013 Apr 14].
• 11 Gunjiyal J, Thomas SM, Gupta AK, Sharma BS, Mathur P, Gupta B, et al. Device associated and multidrug-resistant infections in critically ill trauma patients: Towards development of automated surveillance in developing countries. J Hosp Infect 2011;77:176-7.
• 12 Behera B, Mathur P, Gupta B. Blood culture gram stain, acridine orange stain and direct sensitivity-based antimicrobial therapy of blood stream infection in patients with trauma. Indian J Med Microbiol 2010;28:138-42.
• 13 Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intra-venous-catheter-related infection. N Engl J Med 1977;296:1305-9.
• 14 Collee JG, Diguid JP, Fraser AG. Mackie and McCartney Practical Medical Microbiology. 14^th ed. Edinburgh: Churchill Livingstone; 1996.
• 15 Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, 19^th informational supplements. 2009; M100-S16.
• 16 Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004;39:309-17.
• 17 Trautner BW, Darouiche RO. Catheter-associated infections: Pathogenesis affects prevention. Arch Intern Med 2004;164:842-50.
• 18 Katherason SG, Naing L, Jaalam K, Ismail A. Baseline assessment of intensive care-acquired nosocomial infection surveillance in three adult intensive care units in Malaysia. J Infect Dev Ctries 2008;2:364-8.
• 19 Hughes AJ, Ariffin N, Huat TL, Abdul Molok H, Hashim S, Sarijo J, et al. Prevalence of nosocomial infection and antibiotic use at a university medical center in Malaysia. Infect Control Hosp Epidemiol 2005;26:100-4.
• 20 Rozaidi SW, Sukro J, Dan A. The incidence of nosocomial infection in the intensive care unit, Hospital Universiti Kebangsaan Malaysia: ICU acquired nosocomial infection surveillance program 1998-1999. Med J Malaysia 2001;56:207-22.
• 21 Agodi A, Auxilia F, Barchitta M, Brusaferro S, D′Alessandro D, Montagna MT, et al. GISIO. Building a benchmark through active surveillance of intensive care unit-acquired infections: The Italian network SPIN-UTI. J Hosp Infect 2010;74:258-65.
• 22 Remirez Barba EJ, Rosenthal VD, Higuera F, Oropeza MS, Hernandez HT, Lopez MS, et al. Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals. Am J Infect Control 2006;34:244-7.
• 23 Mathur P, Kapil A, Das B, Dhawan B. Epidemiology and microbiology of nosocomial bacteremia at an Indian tertiary care hospital. Trop Doct 2005;35:53-4.
• 24 Ahmed SH, Daef EA, Badary MS, Mahmoud MA, Abd-Elsayed AA. Nosocomial blood stream infection in intensive care units at Assiut University Hospitals (Upper Egypt) with special reference to extended spectrum beta-lactamase producing organisms. BMC Res Notes 2009;2:76.
• 25 Deris ZZ, Harun A, Omar M, Johari MR. The prevalence and risk factors of nosocomial Acinetobacter blood stream infections in tertiary teaching hospital in tertiary teaching hospital in north-eastern Malaysia. Trop Biomed 2009;26:123-9, 219-22.