Methods: Retrospective chart review was done of patients with Bcc bacteremia over the period 2012-17. Patient risk factors, outcome, sensitivity profile were looked into. Possible sources for Bcc were analysed.
Results: 22 patients with Bcc bacteremia were identified during this period. Age of patients ranged from 16 months to 83 years, averaging 47 years. 89.5% were nosocomial; 77.3 % had indwelling vascular catheter, either CVC, dialysis catheter or permacath. When 30 days mortality was looked at, 17 patients survived and 5 patients expired. Those who expired had high Pitt’s bacteremic score (scoring done either prior to or within 48 hours of positive culture). 4 patients had underlying pneumonia, among whom 2 patient’s respiratory sample grew Bcc, 3 also had underling vascular catheters. Sensitivity pattern of Bcc was noted as follows- trimethoprim sulfamethoxazole was uniformly sensitive (100%), ceftazidime was sensitive in 86.5%, minocycline in 73% of isolates. Meropenem was tested in 19 and was found sensitive in 15 isolates (79%), fluoroquinolone was tested only in 8 isolates and was sensitive in 7.
As majority was CLABSI, the bundle compliance and common products used for cvc were audited. Feedback and training for bundle compliance were given. The ultrasound gel, even the unopened bottle used for cvc insertion grew Bcc. Despite sterile cover around the probe after the application of contaminated gel, an associated risk was considered and was replaced with sterile gel sachet. At 3 months follow-up there is no further incidence of Bcc bacteremia, though longer follow-up is needed.
Conclusion: Bcc bacteremia is found to be an important nosocomial pathogen, commonly associated with intravascular catheters with 22.7% mortality in this study. Cotrimoxazole was 100% sensitive. Good infection control practices, including early removal of unnecessary catheters are important to prevent Bcc CLABSI. Ultra sound gels can harbour Bcc and poses a serious risk of infection.
S. Suju, None