P4.13: Central line-associated blood stream infection (CLABSI) complications seen in total paranteral nutrition (TPN) in patients admitted to intensive care unit (ICU)

Abstract

Introduction: Total parenteral nutrition (TPN) is used when gut fails to provide complete nutrition. Central line sssociated blood Stream infection (CLABSI) is a major complication of this therapy. It is defined as a laboratory-confirmed blood-stream infection not related to an infection at another site that develops within 48 hours of a central line placement. Of all the healthcare-associated infections, CLABSIs are known as the most costly, and most cases are preventable with proper aseptic techniques, surveillance, and management strategies.The objective of this study was to report the incidence of CLABSI and associated mortality in patients admitted to our intensive care unit (ICU) whom started on TPN. Methods: The study was approved by our institution’s Ethics Committee (no: 23/01/2019, B.10.1.TKH.4.34.H.GP.0.01/8). All patients who received TPN in our adult ICUs from the period between January 01, 2018 till December 31, 2018 were included. Data were retrieved from the hospital electronic data base. Total number of patients receiving TPN and catheter-related complications were recorded. Demographics and CLABSI rates were documented. In the case of tunneled catheters, the definition was changed as follows; signs of inflammation confined to an area (typically < 2 cm) surrounding the catheter exit site and the presence of exudate that proves to be culture positive. Results: A total of 186 patients were determined to receive TPN in adult ICUs for a one-year period. There were 92 males (49.4 %) and 94 females (50.5 %). The incidence of CLABSI was 4.8 % (n=9) during this period. The average duration of TPN was 16 days (range 2–430 days). The great majority of catheters was transient (n=184, 98.9 %). Empiric antibiotherapy till the results of blood cultures obtained were started, and all catheters were removed and cultured. Acinetobacter baumanni and pseudomonas aeruginosa were the most commonly isolated bacterial infectious agents (66.6 %). Staphylococcus aureus (SA), methicillin resistant SA (MRSA), coagulase-negative staphylococci, enterococci, klebsiella and the other gram-negative bacilli and fungal infections constituted the smallest group (33.3 %) in our CLABSI series. Conclusion: CLABSI is a very common problem in the intensive care unit. These infections can cause mortality, and costly. Only through best practices, protocols, checklists, and establishing a culture of patient safety in healthcare institutions can one reduce CLABSI to zero.