Epidemiology of non-central line-associated primary bloodstream infections in a network of Indian hospitals: A prospective surveillance study over 7 years (2017-2024)

Objectives To estimate the profile of non-central line-associated primary bloodstream infections (non-CLABSIs) in intensive care units of Indian hospitals participating in the standardized health-care-associated infection surveillance program. Methods This is a multicentric, network-based, prospective surveillance study conducted in 180 individual intensive care units of 47 Indian tertiary care hospitals that were part of the Health-Care-Associated Infection Surveillance Network between May 2017 and April 2024. The non-CLABSIs were defined, monitored, and observed using standardized definitions and surveillance protocols ( www.haisindia.com ). Results A total of 7092 laboratory-confirmed non-CLABSI cases and 30,74,954 patient days from 2017 to 2024 were recorded. The overall pooled non-CLABSI rate was 2.3 per 1000 patient days. Gram-negative isolates were the most predominant (5240/7659; 68.4%), including Klebsiella spp. (1766/5240; 33.7%), Acinetobacter baumannii (1613/5240; 30.8%), and Escherichia coli (582/5240; 11.1%). Gram-positive isolates (1728/7659; 22.6%) predominantly included Staphylococcus aureus (953/1728; 55.1%) and Enterococcus spp. (747/1728; 43.2%). Carbapenem resistance was common in Gram-negative infections, particularly in A. baumannii (1253/1554; 80.6%) and Klebsiella spp. (1209/1697; 71.2%). Among Gram-positive, S. aureus exhibited a high level of resistance to methicillin (529/748; 70.7%). Conclusions This surveillance study underscores the need to expand infection prevention and control strategies to include non-device-associated risk factors. This will lead to the formulation of comprehensive infection prevention and control programs, mitigating the burden and clinical outcomes of non-CLABSI.