Case Control Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Sep 9, 2021; 10(5): 220-231
Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.220
Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain: Four years’ experience
Safaa Al-Khawaja, Nermin Kamal Saeed, Sanaa Al-khawaja, Nashwa Azzam, Mohammed Al-Biltagi
Safaa Al-Khawaja, The Infection Disease Unit, Department of Internal Medicine, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama P.O. Box 12, Bahrain
Safaa Al-Khawaja, Department of Internal Medicine, Arabian Gulf University, Kingdom of Bahrain, Manama P.O. Box 26671, Bahrain
Nermin Kamal Saeed, The Medical Microbiology Section, Pathology Department, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama P.O. Box 12, Bahrain
Nermin Kamal Saeed, The Microbiology Section, Pathology Department, Irish Royal College of Surgeon, Manama P.O. Box 15503, Bahrain
Sanaa Al-khawaja, The Intensive Care Unit, Salmaniya Medical Complex, Ministry of Health, Kingdom of Bahrain, Manama P.O. Box 12, Bahrain
Nashwa Azzam, The High Institute of Public Health, Alexandria University, Alexandria, Egypt
Mohammed Al-Biltagi, The Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, Manama P.O. Box 26671, Bahrain
Mohammed Al-Biltagi, Pediatric Department, Faculty of Medicine, Tanta University, Tanta P.O. Box 31512, Alghrabia, Egypt
Author contributions: Al-Khawaja S, Saeed NK, Al-Khawaja S, Azzam N and Al-Biltagi M did the research, collected the data, wrote, and revised the manuscript.
Institutional review board statement: We performed to study according to the latest version of Helsinki's Declaration. The Research and Ethics Committee at the Ministry of Health, Kingdom of Bahrain, approved the study.
Informed consent statement: We did not collect consent as the study is an observational one.
Conflict-of-interest statement: None of the authors had potential conflicts of interest to be disclosed.
Data sharing statement: Data are available upon reasonable request.
STROBE statement: The authors have read the STROBE statement, and the manuscript was prepared and revised according to the STROBE statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Mohammed Al-Biltagi, MD, PhD, Chairman, Professor, The Pediatrics, University Medical Center, King Abdulla Medical City, Arabian Gulf University, 61 Building, Abdulaziz Venue, 328 Block, Manama P.O. Box 26671, Bahrain. mbelrem@hotmail.com
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: June 17, 2021
Revised: June 17, 2021
Accepted: July 20, 2021
Article in press: July 20, 2021
Published online: September 9, 2021
Processing time: 197 Days and 21.4 Hours
Abstract
BACKGROUND

The central venous line is an essential component in monitoring and managing critically ill patients. However, it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.

AIM

To define the trends of the rates of central line-associated bloodstream infections (CLABSI) over four years, its predicted risk factors, aetiology, and the antimicrobial susceptibility of the isolated pathogens.

METHODS

The study was a prospective case-control study, performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit (ICU) and auditing the implementation of its prevention bundle.

RESULTS

Thirty-four CLABSI identified over the study period, giving an average CLABSI rate of 3.2/1000 central line days. The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018. The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms (59%). The most common offending organisms were Acinetobacter, Enterococcus, and Staphylococcus epidermidis, each of them accounted for 5 cases (15%). Multidrug-resistant organisms contributed to 56% of CLABSI. Its rate was higher when using femoral access and longer hospitalisation duration, especially in the ICU. Insertion of the central line in the non-ICU setting was another identified risk factor.

CONCLUSION

Implementing the prevention bundles reduced CLABSI significantly in our ICU. Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.

Keywords: Bloodstream infection; Central line; Intensive Care Unit; Microbiology; Prevention bundle; Kingdom of Bahrain

Core Tip: The study aimed to define the trends of the rates of central line-associated bloodstream infections (CLABSI) over four years, its predicted risk factors, aetiology, and the antimicrobial susceptibility of the isolated pathogens. We found that implementing the prevention bundles reduced CLABSI significantly in our intensive care unit (ICU). Therefore, implementing and reinforcing the CLABSI prevention bundle are crucial to substantially reducing the CLABSI rate in the ICU setting.