Profile of central line-associated bloodstream infections in adult, paediatric, and neonatal intensive care units of hospitals participating in a health-care-associated infection surveillance network in India: a 7-year multicentric study

Background: Central line-associated bloodstream infections (CLABSIs) are preventable health-care-associated infections (HAIs) that cause considerable morbidity and mortality. Understanding the epidemiology of CLABSIs through large, quality-assured, hospital-based datasets could help to enable development of preventive protocols suited to specific health-care systems. We aimed to describe the profile of CLABSIs in intensive care units (ICUs) at tertiary care centres in India. Methods: We obtained data from around 200 adult, paediatric, and neonatal ICUs at 54 hospitals reporting to the Indian HAI surveillance network over a period of 7 years. All hospitals conducted bloodstream infection surveillance using standardised protocols. Cases of CLABSI were recorded on standard case report forms and were submitted to the HAI surveillance database. Denominator data (patient-days and central line-days) were entered monthly. Data quality was evaluated by a central team at the All-India Institute of Medical Sciences (New Delhi, India). We calculated CLABSI rates per 1000 central line-days and central-line utilisation ratio (CLUR) by year and ICU type (adult, paediatric, or neonatal). Commonly reported pathogens were ranked and the proportions of priority pathogens showing antimicrobial resistance were also estimated for each 1-year period and each ICU type. Findings: During the surveillance period from May 1, 2017 to April 30, 2024, 8629 laboratory-confirmed CLABSI events, 3 054 124 patient-days, and 977 052 central line-days were recorded. The overall pooled CLABSI rate was 8·83 per 1000 central line-days and the pooled CLUR was 0·32. CLABSI rates were 8·68 per 1000 central line-days in adult ICUs (CLUR 0·38), 6·71 per 1000 central line-days in paediatric ICUs (0·27), and 13·86 per 1000 central line-days in neonatal ICUs (0·11). Among the total 10 042 pathogens reported, 8981 (89·4%) were bacterial and 1061 (10·6%) were fungal; Klebsiella pneumoniae (2294 [22·8%] isolates) and Acinetobacter baumannii (2047 [20·4%] isolates) were the most frequently reported for each ICU type. Among isolates tested, resistance to carbapenem was found to be highest in A baumannii (1607 [87·1%] resistant isolates of 1846 tested) and K pneumoniae (1589 [77·7%] of 2046). Interpretation: This is the first large-scale observational study and standardised surveillance report of CLABSI in India. The data generated from this network provide a valuable opportunity for a quality improvement-based approach for the reduction of CLABSI. Funding: US Centers for Disease Control and Prevention cooperative agreement with the All-India Institute of Medical Sciences (New Delhi, India). Translation: For the Hindi translation of the abstract see Supplementary Materials section.