Afroz Z, Jobayer M, Ahmed S, Anwar S, Miah M R A
Bangladesh Med Res Counc Bull. 2015 Aug;41(2):89-94. doi: 10.3329/bmrcb.v41i2.29989.
Central venous catheter-related bloodstream infections (CVC-BSI) are associated with morbidity and mortality especially in critically ill patients. This study was performed to find out the rate of CVC-BSI and CVC colonization, causative organism and their antibiogram in patients of Intensive Care Unit (ICU) and Department of Nephrology of tertiary care hospitals. A total of 100 patients from Bangabandhu Sheikh Mujib Medical University (BSMMU) and Dhaka Medical College Hospital (DMCH) who had-CVC and clinically suspected of septicemia were included in the study. Paired CVC blood and peripheral venous blood (PVB) samples were collected from each patient and were cultured by automated blood culture method. CVC-BSI was diagnosed in 11% and CVC colonization in 43% patients by Differential time to positivity (DTP) method. Rate of CVC-BSI was 8/1000 CVC days and 11/1000 CVC days in BSMMU and DMCH respectively whereas CVC colonization rate was 32/1000 CVC days and 47.5/1000 CVC days in BSMMU and DMCH. The most common bacteria causing CVC-BSI was Klebsiella spp. (36.4%) followed by Acinetobacter spp. (27.3%), Pseudomonas spp. (18.2%) and E. coli (18.2%). Among bacteria isolated from CVC colonization majority were Pseudomonas spp. (30.23%) and Staphylococcus epidermidis (30.23%) followed by Acinetobacter spp. (27.91%), Enterococcus spp. (6.98%). Most of the isolated bacteria causing CVC-BSI were resistant to commonly used antibiotics, but showed good sensitivity to imipenem and colistin. Information about CVC-BSI, -colonization and antibiogram of this study can help to guide the selection of suitable antibiotics for empirical therapy and to improve infection control measures of the hospital.
中心静脉导管相关血流感染（CVC-BSI）与发病率和死亡率相关，尤其是在重症患者中。本研究旨在查明三级护理医院重症监护病房（ICU）和肾脏病科患者中CVC-BSI的发生率、CVC定植情况、致病微生物及其抗菌谱。来自班加班杜·谢赫·穆吉布医科大学（BSMMU）和达卡医学院医院（DMCH）的100例留置CVC且临床怀疑败血症的患者被纳入研究。从每位患者采集配对的CVC血样和外周静脉血（PVB）样本，并采用自动血培养方法进行培养。通过阳性时间差（DTP）法诊断出11%的患者发生CVC-BSI，43%的患者存在CVC定植。BSMMU和DMCH的CVC-BSI发生率分别为每1000个CVC日8例和11例，而BSMMU和DMCH的CVC定植率分别为每1000个CVC日32例和47.5例。引起CVC-BSI最常见的细菌是克雷伯菌属（36.4%），其次是不动杆菌属（27.3%）、假单胞菌属（18.2%）和大肠杆菌（18.2%）。在从CVC定植中分离出的细菌中，大多数是假单胞菌属（30.23%）和表皮葡萄球菌（30.23%），其次是不动杆菌属（27.91%）、肠球菌属（6.98%）。大多数引起CVC-BSI的分离细菌对常用抗生素耐药，但对亚胺培南和黏菌素表现出良好的敏感性。本研究关于CVC-BSI、定植情况和抗菌谱的信息有助于指导经验性治疗中合适抗生素的选择，并改善医院的感染控制措施。
