A Study on Indwelling Medical Device Associated Nosocomial Infections with Special Reference to Biofilm Production and Antibiotic Resistance in a Tertiary Care Centre.

Introduction- Nosocomial infections are an important public health problem, frequently encountered in ICUs in resource limited countries. ICU patients with compromised immunity, empirical use of antimicrobial agents and the superimposed complex nature of bacterial biofilms colonizing indwelling medical devices have resulted in resistant device-related nosocomial infections. Management of such infections is now a huge challenge, as they lead to persistent and resistant infections Materials and Method- This prospective study was conducted in a tertiary care hospital. 156 patients with indwelling medical devices (66 with intravascular catheters, 48 with endotracheal tubes and 42 with urinary catheters) were studied using the semi-quantitative method. Identification of the organism was performed as per the standard microbiological procedures. Antibiotic susceptibility was performed using Vitek 2K automated method. Detection of biofilm was performed by Tube adherence test. Results- In the present study 156 patients with indwelling medical devices (66 with intravascular catheters, 48 with endotracheal tubes and 42 with urinary catheters) were studied. Among them 55 (35%) developed device related infections, 29(44%) in CRBSI, 10 (20.8%) and 15 (35.7%) in VAP and CAUTI respectively. Klebsiella pneumoniae was more frequently isolated from the devices followed by Pseudomonas aeruginosa, isolates from these devices were multidrug resistant. Of the 55 isolates tested for biofilm formation, strong biofilm producers were 22 (40 %), 23 (42%) were moderate and 10 (18%) isolates were considered as non biofilm producers. Klebsiella pneumoniae was the predominant isolate isolated from the biofilms. 96% of these biofilm isolates were multidrug resistant. Conclusion-Device-related multi drug resistant nosocomial infections are becoming more frequent in ICU patients, accounting for patient morbidity, attributable mortality, excess costs and prolonged length of hospital stay. This study emphasizes the implementation of antimicrobial stewardship and surveillance programmes targeted on device-related nosocomial infections, complemented with the performance of other practices for control and prevention. [ABSTRACT FROM AUTHOR]