VENOUS CATHETER TIP INFECTIONS IN INTENSIVE CARE UNITS OF A TERTIARY CARE HOSPITAL

Venous Catheter Tip Infections

Abstract

Objective: To determine the local and changing patterns of bacterial growth and antibiotic sensitivity for appropriate empiric treatment before culture results are available.
Study Design: Retrospective observational study.
Place and Duration of Study: This study was conducted at Khan Research Laboratories Hospital, Islamabad, Pakistan, from Jul 2014 to Dec 2016.
Material and Methods: One hundred and seventy five patients having positive cultures of venous catheter tips performed after following  standard protocol were included. Age, gender, common pathogens, their sensitivity and resistance to 27 antimicrobial drugs were taken into account. Statistical Package for Social Sciences (SPSS) version 20 was used for data analysis.
Results: Total number of patients included were 175. 56.5% (n=99) were females while 43.4% (n=76) were males.Minimum age was 16 years while maximum age was 93 years. Mean age was 58.15 ± 17.94 years. 175 patients having culture positive venous catheter tips, were available for analysis. Majority of the patients were admitted in Medical ICU, 78.3% (n=137). Staphylococcus epidermidis (S. Epidermidis) was the most common isolate 24.6% (n=43) followed by Escherichia coli (E. coli) 21.7% (n=38), Staphylococcus aureus (S.aureus) 18.8% (n=33), Klebsiella pneumonia(K. pneumoniae) 14.3% (n=25), Acinetobacter baumannii (A.baumannii) 5.7% (n=10). S. epidermidis showed maximum sensitivity to Linezolid i.e. 100% followed by Minocyclin, 88%, Vancomycin 86%. It was resistant to Ampicillin 93%. E. colishowed maximum sensitivity to Amikacin i.e. 95% followed by Imipenem 87%, while being resistant to Amoxicillin/clavulanic acid (97%) and Ciprofloxacin (92%). Staphylococcus aureus showed maximum sensitivity to Linezolid i.e. 97% followed by Vancomycin (90%) while showing resistance to Ampicillin (100%), Ciprofloxacin(88%) and Levofloxacin (85%). Klebsiella pneumoniae showed decreased sensitivity to Amikacin, Imipenem,Meropenem i.e. 64% while 100% resistant to Amicillin, Amoxicillin/clavulanic acid. Acinetobacter baumannii showed maximum sensitivity to Colistin i.e. 90%. Pseudomonas aeruginosa showed maximum sensitivity to Polymyxin B (100%) and Colistin (87%), while resistant to Ceftazidime and Quinolones (37%).
Conclusion: Antibiotic pool for catheter related infections is shrinking. Commonly used as well as reserved antibiotics are no longer effective as before.
Keywords: Antimicrobial sensitivity and resistance, Catheter related blood Linezolid, Stream infections,
Staphylococcus epidermidis, Staphylococcus aureus, Vancomycin.