Catheter related blood stream infections(CRBSI): Incidence, risk factors and antimicrobial susceptibility in a tertiary care hospital

Catheter-related bloodstream infection (CRBSI) is defined as the presence of bacteremia originating from central venous catheter. It is one of the most frequent, lethal, and costly complications of central venous catheterization and also the most common cause of nosocomial bacteremia. Intravascular catheters are integral to the modern practices and are inserted in critically-ill patients for the administration of fluids, blood products, medication, nutritional solutions, and for hemodynamic monitoring. Central venous catheters (CVCs) pose a greater risk of device-related infections than any other types of medical device and are major causes of morbidity and mortality.

 The definitive diagnosis of catheter infection can be made by using a combination of clinical signs and symptoms together with the various culture techniques. Patients with CVC catheters developing fever or chills, unexplained hypotension, and no other localizing sign suggest possibility of CRBSI. Catheter site infection is indicated by the presence of erythema, swelling, tenderness, and purulent drainage around the catheter exit and the part of the tunnel external to the cuff. Risk factors for CRBSI include immunocompromised status, neutropenia Burns, Malnutrition, BMI >40, Prolonged hospitalization before catheter insertion, emergency catheter insertion, incomplete adherence to aseptic technique, multiple manipulations of the catheter, failure to remove unnecessary catheter. The administration of parenteral nutrition through intravascular catheters increases CRBSI risk. Local risk factors, such as poor personal hygiene, occlusive transparent dressing, moisture around the exit site, S. aureus nasal colonization, and contiguous infections support the role of bacterial colonization in the pathogenesis of CRBSI.

 The antimicrobial susceptibility patterns will help clinician to decide correct choice of antibiotics and antimicrobial stewardship. Antibiotic therapy for catheter-related infection is often initiated empirically. The initial choice of antibiotics depends on the severity of the patient’s clinical disease, the risk factors for infection, and the likely pathogens associated with the specific intravascular device. There are no compelling data to support specific recommendations for the duration of therapy for device-related infection.  Antibiotic therapy for CRBSI is used in conjunction with systemic antibiotic therapy and involves installing a high concentration of an antibiotic, to which the causative microbe is susceptible in the catheter lumen. The likelihood of success varies with the site of infection