STUDY ON MICROORGANISM PROFILE AND COMPARATIVE RESISTANCE PATTERN AMONG CRBSI PATIENTS IN A TERTIARY CARE HOSPITAL OF EASTERN INDIA

Abstract

Central-venous-catheter-related bloodstream infection (CRBSIs) is the most important cause of hospital-acquired blood stream infection associated with morbidity, mortality, and cost. Consequences depend on resistance pattern of the pathogen , underlying co-morbid conditions, whether emergency or elective insertion of CVC, and appropriateness of the treatment/interventions received. 

Objectives: To identify the prevalent bacteriological profile along with determine antimicrobial susceptibility and comparative resistance pattern of isolates from CVC and the peripheral blood .

Materials and Methods: The study was carried out in Department of Microbiology in  collaboration with Department of Critical Care Medicine in a Medical  college Hospital of West Bengal within Jan 2019- Jun 2019

Patients above 18 years of age, willing to give consent and in whom the CVC had been inserted in the Intensive care unit of IPGMER were included in this study.

Aerobic isolates were identified by Gram stain and Microscopy, routine biochemical tests as per standard protocol. Antimicrobial susceptibility of isolates was tested by modified KirbyBauer disk diffusion method as per the recommendations of Clinical and Laboratory Standards Institute (CLSI guidelines).

Result:  Total of 52 patients with a cumulative 204 CVC days were included. Of this, 17 catheters (32.7 %) were positive for SQC. Among these 17 patients, 13 patients (76%) had developed CRBSI, and the same strain of organism with identical resistance pattern was isolated from both the blood and CVC tip.  One patients(11.7%) had positive blood cultures with different organism growing on CVC tip culture . CRBSI rate was 8.3/1000 CVC days.

Discussion: Our study isolated around 60% Gram negative organisms responsible for CRBSI .All the Gram positive organisms isolated in our study found to be CONS,found to be 100% sensitive to Vancomycin , Linezolid and 67% sensitive to Teicoplanin.As per the Gram negative organisms are concerned , the predominant GNB is Klebsiella spp .Overall , Klebsiella spp in our study has poor sensitivity towards commonly prescribed broad spectrum antibiotics , and exerts sensitivity only to Polymyxin B (100%) , Carbapenems ( 60%) and Amikacin (40%). Acinetobacter spp & Psedomonas aeruginosa  showed marked resistance pattern with 100% sensitivity to polymyxin B ,

Conclusion: Multiple measures have been implemented to reduce the risk for CRBSI, including maintenance of strict aseptic precautions during catheter insertion especially in case of emergency insertion, use of maximal barrier, effective cutaneous disinfectant, and preventive strategies based on inhibiting micro-organisms entering from the skin or catheter hub from adhering to the catheter.Further prospective studies with sufficient population size and the bigger study samples is required.