Central Venous Catheter-related Blood Stream Infections: Incidence, Risk Factors and Associated Pathogens in a University Hospital ICU

Central Venous Catheters (CVCs) are indispensable in current intensive care treatment; also pose a greater riskof device related infections in comparison to any other type of medical device and are major cause of morbidity,mortality and increased expense. A cross sectional prospective study of one year duration was conducted inthe tertiary care University Hospital ICU located in the rural region of Haryana, India, to determine the incidenceof the central venous catheter related bloodstream infection (CRBSI), rate of catheter colonization and toidentify the associated risk factors and the microbial spectrum of CRBSI along with the antimicrobial sensitivitypattern of microbial isolates. Sixty patients with central venous catheter inserted and admitted under ICUhaving signs and symptoms of septicaemia post 48 hours of central venous catheter insertion were included.The rate of CRBSI was assessed by paired quantitative blood culture method in the CVC and peripheral vein.The CRBSI incidence was 16.67% and catheter colonization was found to be 53.3%. Methicillin-resistantstaphylococcus aureus and Acinetobacter baumanni were the predominant isolates. A statistically significantassociation of duration of catheterization with CRBSI was found. It is concluded that CRBSI incidence ishigh, with significant association of prolonged duration of catheterization with CRBSI. By knowing the changingtrends of microbial flora, empirical therapy can be formulated for early and effective management of CRBSI.

Microbiological Investigation In Dead Bodies For Prevalence of Tuberculosis.

Despite the availability of effective treatment for most cases, tuberculosis is still a cause of death in our country. Some cases of active tuberculosis are not identified until after the patient had died and an autopsy has been performed. This study was done to determine the prevalence of tuberculosis in autopsy cases.We aimed to determine the infection with Mycobacteriumtuberculosis using Tuberculosis culture in samples that were obtained from lungs of forensic cases whoseautopsies had been performed in the mortuary of our institution.In our autopsy study, out of the 168 tissue samples that were obtained from lungs over a period of three years, only 9 (5.36%) were positive for Tuberculosis in Lowenstein-Jensen medium. For this reason, we think that autopsy workers have to be carefulabout tuberculosis during their autopsy working. Awareness of tuberculosis and its high prevalence in India is essential for minimising missed diagnoses. Absence of suspicion and delayed diagnosis mean increased risk in health care and at autopsy. Although this is a burning issue but the forensic medicine departments in India seem to be taking it lightly.

Pre-testing Screening for HIV before Conducting Post-mortem Examinations.

The concern about contracting an infectious disease during the course of an autopsy is great, a concern heightened when the devastating infections that could be transmitted are considered. The fear and concern, however, appear out of proportion to the actual incidence of such disease transmission. In our autopsy study, out of the total 328 blood samples tested, only 2 (0.6%) samples were found to be HIV seroreactive, over a period of three years. A comparison with similar studies abroad, reveals varied results, which do not represent the population data. However more such studies will be needed in different regions of countries to find any significant pattern or correlation. Although this is a burning issue but the forensic medicine departments in India seem to be taking it lightly. The association of the department with a microbiologist is essential in saving its staff.