Published online Sep 9, 2021. doi: 10.5492/wjccm.v10.i5.220
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
The central venous line is an essential component in monitoring and managing critically ill patients. Central line-associated bloodstream infection (CLABSI) are BSIs developed in patients with central venous catheters. The presence of these infections is associated with a higher risk of morbidity and mortality.
Because we do not have enough data about the rate of CLABSI and the causative organisms in the Kingdom of Bahrain, we would like to estimate the magnitude of the problem in our intensive care units (ICUs). Knowing the microbial profile of CLABSI in our ICU help proper use of the empirical antibiotics therapy in patients with suspected CLABSI.
The study aimed to define the trends of the rates of CLABSI over four years, its predicted risk factors, aetiology, and the antimicrobial susceptibility of the isolated pathogens
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 ICU and auditing the implementation of its prevention bundle.
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.
Implementing the prevention bundles reduced CLABSI significantly in our ICU. Reinforcing CLABSI prevention bundle implementation is crucial to substantially reducing the CLABSI rate in the ICU setting.
We need to study the mechanism of bacterial resistance among patients infected with CLABSI. We also need to study viral coinfection and its effects on morbidity and mortality. We should compare our data with the data from other countries to generalize the obtained results.