Rising incidence of carbapenem resistance in health care associated blood stream infections in a tertiary care hospital in Mumbai, India
Methods: All patients admitted to the adult ICU (mixed medical-surgical) during the study period were included. Blood cultures were sent when sepsis was suspected, processed in the BacT Alert 3D system and the VITEK 2 system used for identification and susceptibility testing. CLABSI were defined as per the Centers for Disease Control (CDC) definitions.
Results: From Jan 2010 to Dec 2013, 20814 adult patients, representing 93751 bed days were enrolled in the study. A total of 8328 central lines were inserted with 50436 central line days. The overall CLABSI rate was 5.67 per 1000 central line device days (286 cases) and ranged from 5.77 in 2010 to 6.62 per 1000 central line device days in 2013.
Overall 80 % of all CLABSIs were caused by Gram Negative Bacilli (GNB’s); 12 % were caused by Gram positive cocci (GPCs) and 7% were caused by Candida species. K. pneumoniae, A. baumannii and P. aeruginosa were the commonest GNB’s. Enterococcus was the commonest GPC (42 % of all GPC), methicillin resistant S. aureus (MRSA) contributed to only 12 %. Fourteen percent of enterococcus were vancomycin resistant (VRE). The incidence of ESBL production in GNB increased from 56% in 2010 to 80% in 2013 while the incidence of carbapenem resistance increased from 0% in 2010 to 43% in 2013. Resistance to Beta-lactam plus beta lactamase inhibitor combinations such as piperacillin-tazobactam increased from 14% in 2010 to 70% in 2013. Also ominious was the rise in fluconazole resistance among Candida isolates from 0% in 2010 to 33% in 2013.
Conclusion: This is the largest single centre study of CLABSI from India. Though the incidence rates are superior than those reported from other centers in India, they are inferior to those reported by the national health and safety network of the USA. The increasing incidence of resistance especially carbapenem resistance in gram negative pathogens is of serious concern. Urgent implementation of effective infection control and antimicrobial stewardship strategies is needed.
R. Naik, None
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