The prevalence of central venous catheter associated infections at the intensive care unit of Kenyatta National Hospital

Abstract

Central venous catheters are important in the management of critical care patients, but the major pitfall is their contribution to nosocomial infections which are an important cause of morbidity and mortality. The study was conducted in K.N.H critical care unit (combined surgical and medical), a hundred patients with age ranging from 7 to 80 years were studied 52 being male and 48 female. The diagnoses were categorized into infectious, non infectious and trauma. The prevalence of Catheter related blood-stream infections was 12% (95% C.I 5.6 to 18.36%). Central venous catheter tip colonisation prevalence being 13%. The majority of organisms qualifying for CRBI were gram negative organisms (10 out of 12), the leading one being klebsiella pneumoniae. The study did not show significant difference in gender predisposition towards Catheter related blood-stream infections. Patients older than 40 years showed greater predisposition to Catheter related blood-stream infections with 50% of the CRBI being in this category. Previous and current antibiotic use did not influence occurrence of catheter related infections. In this study steroids, blood and blood-products and parenteral nutrition were not statistically shown to influence occurrence of bloodstream infections. Occurrence of signs of sepsis did not indicate occurrence of Catheter related blood-stream infections. The level of blood sugar and packed cell volume also did not influence occurrence of Catheter related blood-stream infections while renal and hepatic organ impairment were a predisposition. However respiratory and urinary tract infections did not put patients at risk of catheter related bloodstream infections.

The gram positive organisms identified (staphylococcus aureus and epidermidis) were sensitive to Linezolid, Vancomycin, Gentamycin and Clindamycin. They were resistant to Augmentin, Cefuroxime and others. On the other hand gram negative organisms were sensitive to Imipenem, Meropenem, Amikacin, Tazocin-piperacillin and Cefepime. Resistance was shown to Augmentin, Nalidixic acid, Doxycyline and Ampicillin. Varying patterns of resistance were shown to the other antibiotics. The only fungus grown was candida albicans and this showed no resistance to the common antifungals tested.