Arunan Bharathi, Ahmed Nishat H, Kapil Arti, Vikram Naval K, Sinha Sanjeev, Biswas Ashutosh, Satpathy Gita, Wig Naveet
Department of Medicine and Microbiology, All India Institute of Medical Sciences, New Delhi, India.
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India.
J Glob Infect Dis. 2023 May 31;15(2):59-65. doi: 10.4103/jgid.jgid_213_22. eCollection 2023 Apr-Jun.
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.
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.
was responsible for 48% of CLABSI, followed by Coagulase-negative (16%) and and (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 ( value for total bilirubin 0.001 and for aspartate transaminase 0.02), and those infected with multidrug-resistant organisms ( 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.
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.
使用中心静脉导管的患者通常患有多种疾病，侵入性设备为生物膜形成提供了一个适宜环境，这使得中心静脉导管相关血流感染（CLABSI）成为医疗机构中一个严重问题，因为这类感染难以治疗。在本研究中，我们评估了导致CLABSI的常见细菌以及影响临床结局的各种患者和病原体因素。
在这项前瞻性观察研究中，招募了被诊断为CLABSI的患者。进行了广泛的临床、微生物学和其他实验室检查，并记录了观察结果。采用刚果红琼脂法、试管试验和微量滴定板试验来检测细菌病原体的生物膜形成特性。
导致48%的CLABSI，其次是凝固酶阴性葡萄球菌（16%）以及金黄色葡萄球菌和肠球菌（各占12%）。56%的分离株产生生物膜。直至死亡或出院的住院时间中位数（四分位间距）为30（20，43）天。全因死亡率为44%。诊断当天肝功能紊乱的患者（总胆红素P值=0.001，天冬氨酸转氨酶P值=0.02）以及感染多重耐药菌的患者（P值=0.04）预后明显较差。未发现生物膜产生菌感染患者与非生物膜产生菌感染患者在人口统计学、临床、实验室特征及结局方面的差异具有统计学意义。
本研究揭示了决定CLABSI患者病因和结局的各种宿主和病原体因素。据我们所知，这是第一项试图解读生物膜形成在病原体毒力及CLABSI预后中作用的研究。
