Epidemiology of blood stream infections at a level-1 trauma care center of India.
OBJECTIVE
Bloodstream infections (BSIs) are one of the major life-threatening infections in hospitals. They are responsible for prolonged hospital stays, high healthcare costs, and significant mortality. The epidemiology of BSIs varies between hospitals necessitating analysis of local trends. Few studies are available on trauma patients, who are predisposed due to the presence of multiple invasive devices.


METHODS
A prospective surveillance of all BSIs was done at a level 1 trauma center from April, 2011 to March, 2012. All patients admitted to the different trauma intensive care units (ICUs) were monitored daily by attending physicians for subsequent development of nosocomial BSI. An episode of BSI was identified when patients presented with one or more of the following signs/symptoms, that is, fever, hypothermia, chills, or hypotension and at least one or more blood culture samples demonstrated growth of pathogenic bacteria. BSIs were further divided into primary and secondary BSIs as per the definitions of Center for Disease Control and Prevention. All patients developing nosocomial BSIs were followed till their final outcome.


RESULTS
A total of 296 episodes of nosocomial BSIs were observed in 240 patients. A source of BSI was identified in 155 (52%) episodes. Ventilator-associated pneumonia was the most common source of secondary BSI. The most common organism was Acinetobacter sp. (21.5%). Candida sp. accounted for 12% of all blood stream organisms. A high prevalence of antimicrobial resistance was observed in Gram-negative and-positive pathogens.


CONCLUSIONS
Trauma patients had a high prevalence of BSIs. Since secondary bacteremia was more common, a targeted approach to prevention of individual infections would help in reducing the burden of BSIs.
Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Purva
P
Mathur
Department of Laboratory Medicine, Hospital Infection Control, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Prince
P
Varghese
Department of Laboratory Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Vibhor
V
Tak
Department of Laboratory Medicine, Hospital Infection Control, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Jacinta
J
Gunjiyal
Department of Forensic Medicine, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Sanjeev
S
Lalwani
Department of Surgery, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Subodh
S
Kumar
Department of Surgery, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
Mahesh C
MC
Misra
Central line associated-BSI; ICUs; nosocomial blood stream infections; secondary bacteremia; trauma