الفهرس 
CENTRAL LINE ASSOCIATED BLOOD STREAM INFECTION OVERVIEWOnly 14 pages are availabe for public view
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Abstract
OBJECTIVE: This study aimed to measure central line associated blood stream infection (CLA-BSI) incidence density rate, study its risk factors and to identify pathogen specific incidence rates of CLA-BSI in patients of Intensive Care Units (ICUs). The study also aimed to examine the trend of CLA-BSI rates among patients in ICUs throughout the last five years; from 2009 to 2013 at Dar-alfouad Hospital.
DESIGN of study: A prospective cohort epidemiological study was carried out in Medical/coronary and Surgical ICUs at Dar-alfouad Hospital in order to estimate the rate of CLA-BSI, most common pathogens causing it and factors related to its occurrence. To examine the trend of CLA-BSI, a retrospective study revising the ICU records of last five years was applied.
PATIENTS and METHODS: A total of 499 patients were enrolled in the current study. The patients were prospectively followed throughout the study period (6 months) from April 2014 to September 2014, at the Surgical and Medical/Coronary ICUs for detection of CLA-BSIs. The observation was performed after admission until removal of catheter, patient death or discharge. Data collection sheets were filled by infection control staff to collect and record preoperative data for ICU patients with central venous catheters (CVCs).
RESULTS: The study revealed that nearly forty four percent of all patients admitted to ICUs had CVC insertion (43.7%), nineteen patients developed CLA-BSI at the end of the study period and 480 patients were not infected. The overall incidence density rate of CLA-BSI was 6 cases per 1000 CL-days. The central line utilization ratio was 0.94 (94.0 device are used per 1000 patient days). Our CLA-BSI rate increased from 1.6 in year 2009 to 5.6 in 2013. There was a high percentage of mortality among cases with CLA-BSI (47.4%) during the study period. Risk factors of CLA-BSI which were detected by univariate analysis includes associated co-morbidities as heart failure, high APACHE II scores >15, length of ICU stay 5 days or more, duration of CVC placement, subclavian insertion of CVCs, and mechanical ventilation. However; there were no statistical significant association between age, gender, length of hospital stay before the ICU admission, type of the ICU, place of admission to ICU and occurrence of CLA-BSI. Risk factors which were detected by multivariate logistic regression analysis includes a long ICU stay 5 days or more, Mechanical ventilation and presence of heart failure.
Abstract
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Gram-negative bacteria, especially Enterobacter (36.8%) and Pseudomonas aeruginosa (21.1%) were the predominant organisms detected in CLA-BSI cases in the current study.
CONCLUSION: CLA-BSI is an important cause of mortality in ICU patients. Nearly, half of the infected cases died in the current study. The incidence rate of CLA-BSI in the studied ICU patients increased from 1.6/ 1000 CL-days in 2009 to 6/ 1000 CL-days in 2014. The infection rate is considerably higher than in recent studies from developed counties, but is the same as in developing countries. Nevertheless, it was still lower than the rates reported in comparable published studies in Egypt. Length of ICU stay ≥ 5 days, heart failure and mechanical ventilation were independent risk factors for CLA-BSI.
Keywords: Adults; Central Line Associated Blood Stream Infection; cohort study; Intensive Care Unit; Incidence density rate; Risk factors.