PURPOSE: A central venous catheter blood stream infection (CVCBSI) is one of the most common nosocomial infections in an intensive care unit (ICU), resulting in increased morbidity and mortality. The purpose of this analysis was to provide a descriptive analysis of CVCBSIs in a medical ICU and to examine possible associations with certain risk factors in greater detail.
METHODS: 1190 patients were admitted to the medical ICU at Westchester Medical Center between January 2003 to December 2005. Data was collected retrospectively and primary bloodstream infections were identified based on CDC National Nosocomial Infections Surveillance.
RESULTS: Over the 3 years, a total of 50 CVCBSIs were identified in 44 patients (Males=27, Females=17, Age range=21–91). There were a total of 70 CVCs in these 44 patients at the time of the BSI of which 55.7% (39/70) were triple lumen catheters, 42.8% (30/70) were dialysis catheters, and 1.4% (1/70) were peripherally inserted central catheters. Of these catheters, the Internal Jugular vein was the most common site (29/70; 41.4%), followed by Subclavian vein (21/70; 30%) and Femoral vein (20/70; 28.6%).Most frequent organisms isolated were Coagulase-negative Staphylococci (18/70; 25.7%) followed by Vancomycin-resistant enterococcus (10/70; 14.3%), fungal species (11/70; 15.7%) and Resistant Acinetobacter baumanii (4/70; 5.7%). Of the 1190 admissions, 152 patients received TPN during their ICU stay. Of these, 19.1 % (29/152) developed a CVCBSI while only 1.4% (15/1038) of the patients not on TPN developed a CVCBSI. Of the patients on TPN who developed a CVCBSI, 65.5% (19/29) died, while 53.3% (8/15) of the patients who developed a CVCBSI but were not on TPN died.
CONCLUSION: TPN and dialysis dependent renal failure are potentially major risk factors for the development of CVCBSIs. However, several confounding factors like length of stay, age, immunosuppression, comorbid conditions, etc were not controlled for in this analysis.
CLINICAL IMPLICATIONS: CVCBSIs are a major source of morbidity and mortality in an ICU. Understanding the factors that lead to their development will help us significantly reduce their burden on the ICU population.
DISCLOSURE: Lisa Paul, None.