Nosocomial Infections - Dr V Ramesh - Critical Care Infectious Disease Course

so today we're going to discuss about

nosocomial infections and in this talk

I'm going to cover catheter-associated

bloodstream infections and catheter

associated urinary tract infections with

a little bit of mention about

asymptomatic bacteriuria let's start

first start talking about the catheter

associated bloodstream infections in the

ICU as you all know hospital-acquired

infections affects millions and millions

of people worldwide this is data from

the West which says that almost 1.5

million people every year are affected

by some kind of a hospital-acquired

infection it's become an enormous burden

economically and for insurance purposes

to the point where in the u.s. insurance

companies do not reimburse if you

develop the hospital-acquired infection

during your ICU stay hence it becomes

very important for us to prevent it and

then subsequently try to address it and

get the patients better as fast as

possible so how about the incidence of

these infections in our country I'm just

going to show you some data this is from

the Rosenthal study in 2006 where they

looked at almost 55 I see use in 46

hospitals in developing countries

including India they looked at almost

21,000 patients and they found that the

overall incidence rate as you can see

this is got 15% chances of a

catheter-related bloodstream infection

and once you develop a catheter-related

bloodstream infection the mortality rate

seems to be somewhere around 35% which

is very very high so it becomes a very

common problem and also seems to be

extremely you know important in terms of

doing this how about only India this is

a study that we have collected data it's

not yet published but I'm just sharing

you here that you here you can see that

the ventilator associated pneumonia

rates are about 65 percent of all the IC

infections two-thirds are ventilator

associated pneumonia almost one-quarter

seemed to be CR BSI and a small

proportion seem to be CAUTI and if you

look at the mortality our mortality of

catheter-related bloodstream infections

is very similar to what the Rosenthal

study showed it's almost 35% mortality

because almost all of these patients are

bacteremic compared to the other

infections and if you just look at the

six months follow-up which we did

two-thirds of the patients are alive at

the end of six months about 10% are dead

and the other 30% we have lost to

follow-up in our study but at least you

know that there is a

aníbal survival if you can get them out

of the hospital over the next six month

period what are the common organisms

causing CR BSA in our country again the

data from Moses study sponsored by the

Indian society of critical care medicine

if you look at the common bugs common

bug the number one bug is probably

Klebsiella in our in our study which is

expected followed by Pseudomonas and

Acinetobacter which is not a surprise

the point I want to make very clearly is

you don't see gram positives here in my

slide at all it forms a very very small

proportion of of the organisms that

cause catheter-related bloodstream

infections right after the 3 gram

negatives comes e---coli in Canada

Canada obviously is a common bug that we

need to be