A recent Indian study has revealed high rates of bloodstream infections associated with the use of central lines, particularly in newborns, across numerous hospitals in India. The seven-year study, published in The Lancet Global Health, assessed data from 200 ICUs in 54 hospitals, highlighting a concerning trend of infections linked to the mismanagement of tubes inserted into large veins for delivering medicines and fluids.
The study, which analyzed data from May 2017 to April 2024, recorded 8,629 laboratory-confirmed cases of central line-associated bloodstream infections (CLABSI) out of 977,052 central line days. The overall pooled CLABSI rate was 8.83 per 1,000 central line-days. This means that there were almost nine infections for every 1,000 days that central lines were used in the ICUs. The rates varied across different ICUs, with adult ICUs recording 8.7 infections per 1,000 central line days, pediatric ICUs at 6.7, and neonatal ICUs showing a higher rate of 13.9. Alarmingly, about 40% of patients with central line infections died within two weeks.
These figures are significantly higher than those reported in the United States, where the rate was 0.87 per 1,000 even during the COVID-19 year of 2020. Researchers indicated that newborns are particularly vulnerable to infections, and the risk increases when they require central lines in ICUs. The study also found that infection rates peaked during the COVID-19 pandemic in 2020-2021, potentially due to overwhelmed ICUs, staff shortages, and inadequate infection control measures.
A major concern highlighted by the study is the prevalence of antibiotic-resistant bacteria and fungi contributing to these infections. Specifically, 87% of Acinetobacter and 78% of Klebsiella infections, two common culprits in such cases, were resistant to carbapenems, a class of antibiotics considered a last resort. Candida auris, a drug-resistant fungal infection, was also identified as a frequent cause. These pathogens can reach central lines through contaminated hands, equipment, or medicines, subsequently entering the bloodstream.
The study emphasizes the urgent need for improved infection control practices in Indian hospitals. Researchers suggest that tracking rates of bloodstream infections in ICUs can help develop preventive measures tailored to the specific needs of the healthcare system. This includes better surveillance systems and preventive measures, especially given the challenges of resource constraints.
According to researchers, this study represents the largest dataset on the epidemiology of CLABSI in ICUs available in India. The findings offer a valuable opportunity for a quality improvement-based approach to reduce CLABSI rates across the country. Experts like Dr. Camilla Rodrigues, consultant microbiologist, emphasize the importance of mobilizing a large network of both public and private hospitals to perform surveillance and address the problems of device-associated infections. Addressing this issue is critical not only for reducing mortality rates but also for alleviating the strain on the public healthcare system caused by extended hospital stays and increased treatment costs associated with antibiotic resistance.
