Central Line-Associated Bloodstream Infections: Effect of Patient and Pathogen Factors on Outcome

Bharathi Arunan; Nishat H Ahmed; Arti Kapil; Naval K Vikram; Sanjeev Sinha; Ashutosh Biswas; Gita Satpathy; Naveet Wig

doi:10.4103/jgid.jgid_213_22

Central Line-Associated Bloodstream Infections: Effect of Patient and Pathogen Factors on Outcome

J Glob Infect Dis. 2023 May 31;15(2):59-65. doi: 10.4103/jgid.jgid_213_22. eCollection 2023 Apr-Jun.

Authors

Bharathi Arunan¹, Nishat H Ahmed², Arti Kapil², Naval K Vikram³, Sanjeev Sinha³, Ashutosh Biswas³, Gita Satpathy², Naveet Wig³

Affiliations

¹ Department of Medicine and Microbiology, All India Institute of Medical Sciences, New Delhi, India.
² Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
³ Department of Medicine, All India Institute of Medical Sciences, New Delhi, India.

Abstract

Introduction: Patients on central lines are often having multiple morbidities, and invasive devices provide a niche for biofilm formation, which makes central line-associated bloodstream infections (CLABSIs), a serious concern in health-care settings, as the infections difficult to treat. In this study, we evaluated the common bacteria causing CLABSI, and various patient and pathogen factors affecting the clinical outcome.

Methods: In the prospective observational study, patients diagnosed with CLABSI were recruited. Extensive clinical, microbiological, and other laboratory workup was done, and observations were recorded. Congo red agar method, tube test, and microtiter plate assay were used for eliciting the biofilm-forming attributes of the bacterial pathogens.

Results: Klebsiella pneumoniae was responsible for 48% of CLABSI, followed by Coagulase-negative Staphylococci (16%) and Staphylococcus aureus and Acinetobacter baumannii (12% each). Fifty-six percent of the isolates produced biofilms. The median (interquartile range) duration of hospital stay till death or discharge was 30 (20, 43) days. The all-cause mortality was 44%. Patients having a deranged liver function on the day of diagnosis (P value for total bilirubin 0.001 and for aspartate transaminase 0.02), and those infected with multidrug-resistant organisms (P value = 0.04) had significantly poor prognosis. The difference in the demographic, clinical, laboratory profile, and outcome of patients infected with biofilm producers and nonproducers was not found to be statistically significant.

Conclusion: The study throws light on various host and pathogen factors determining the cause and outcome of CLABSI patients. To the best of our knowledge, this is the first study trying to decipher the role of biofilm formation in the virulence of pathogens and the prognosis of CLABSI.

Keywords: Antimicrobial resistance; biofilm formation; central line; central line-associated bloodstream infections.