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One of the largest studies of its kind in India has found high rates of central line-associated bloodstream infections (CLABSIs) and worrying levels of antibiotic resistance in Intensive Care Units (ICUs).
Unlike regular intravenous (IV) lines that go into small veins, a central line is a long, thin tube placed in a large vein—usually in the neck, chest, or groin. It is used to give medications, fluids, or take blood from patients who need long-term care in the ICU.
Researchers from various institutions in the country obtained data for a period of 7 years from around 200 adult, paediatric, and neonatal ICUs at 54 hospitals reporting to the Indian Hospital Acquired Infection (HAI) surveillance network.
The current study assessed the rates of CLABSIs in ICUs with a total of 8,629 laboratory confirmed CLABSI events and 977,052 central line days being recorded from May 2017 to April 2024.
Published in The Lancet Global Health recently, the study found that on average around nine CLABSI events occurred every 1,000 days a central line was in place in ICUs in Indian hospitals.
The rates of CLABSI were 8.7 per 1000 central line days in adult ICUs ( which means there were almost nine infections for every 1000 days that the central lines were used in the ICUs). The rate was 6.7 in paediatric ICUs and 13.9 in neonatal ICUs.
The aim was to describe the profile of CLABSIs in ICUs at tertiary care centres in India. According to the researchers from the Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, Delhi, and other institutions across Chandigarh, Mumbai, Chennai, Vellore, Kochi, Srinagar and others there is a paucity of data on bloodstream infections in LMICs, which limits implementation of country-specific policies for prevention.
Researchers have suggested that infections are often caused by pathogens – which are mcroorganism—such as a bacterium, virus, fungus, or parasite that show worrying resistance to antibiotics. According to researchers,this is the largest dataset on the epidemiology of CLABSI in ICUs available in India . Between 2017 and 2024, resistance to key priority pathogens showed some concerning trends. For instance Enterobacterales and K pneumoniae appeared to show an overall increase in the prevalence of carbapenem resistance throughout the period, particularly in neonatal and paediatric ICUs as per the report.
Dr Camilla Rodrigues, consultant microbiologist at P,D Hinduja Hospital and Medical Research Centre, Mumbai and one of the researchers of the study said that Prof Purva Mathur from the Department of Laboratory Medicine and Hospital Infection Control, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi has managed to mobilise a large network – both public and private hospitals to perform surveillance and address the problems of device associated infections with central lines, ventilators , urinary catheters and so on. “This is a sterling initiative,” Prof Rodrigues said while Dr Kapil Zirpe, Head of Department of Neuro-Trauma Intensive Care Unit at Ruby Hall Clinic, Pune (not part of the study) and who is Chair, Asia Ocean chapter of the Neuro Critical Care Society told The Indian Express that it is important to prioritize antimicrobial stewardship (careful and responsible use of antibiotics), focusing on infection prevention, adequate staffing, and large-scale regular training audits across all critical care areas such as ICUs, transplant units, and operating theatres.
