This study examined the incidence, clinical and microbiological characteristics of the development of catheter-related infections at a tertiary health care centre. Of the 150 patients, 40 (26.7%) developed a bloodstream infection 4-5 days after CVC insertion. The age group 50 to 60 years old had the highest number of CLABSI cases.¹⁰ In our study, catheter colonisation occurred at a rate of 30% (45). The incidence of catheter colonisation in various other studies ranged from 36% to 70%.^11,12 which was co related to our study. Gram-positive Cocci colonised the catheters the most (17.78%), followed by Klebsiella pneumoniae12 (26.67%), Escherichia coli 8 (17.78%), Acinetobacter baumanii 4 (8.89%), and Pseudomonas aeruginosa 4 (8.89%). Gram-positive cocci were the most predominant colonisers of central lines, as said in other research.^13,14 Among the 150 cases, the most common site for central line catheter insertion was subclavian (50%), followed by jugular (40%), and femoral (10%). Out of 40 cases of CLABSI, the highest percentage of infection was discovered in the femoral catheter (80%),^15-17 followed by the jugular catheter (60%) and the subclavian catheter (30%), with a p-value of <0.0031, which was statistically significant and was calculated by the Chi-square test. The occurrence of CLABSI in different site reported by YazanHddadin et al.¹⁸ was related to our study.

In our observation, the CLABSI rate per 1000 days on the central line was 7.8, which was consistent with SZ Bukhari et al. benchmark of 6.8.¹⁸ Fluctuation in the rates of CLABSI could be attributed to differences in methods employed for blood culture (manual or automated), volume of blood used (5 or 10 ml), number of blood cultures taken (2 or 3 sets), and the lack of clinical indications (variations in clinical signs and symptoms of BSI), eventually increasing the proportion of negative results.¹⁹ Besides, the sample size, nature of patients, design of study, geographical locations, blood culturing rates as well as infection control strategies followed in different countries might have also contributed.^20-22 Above all, infections caused by anaerobes and other etiological agents would had add to this disparity, with respect to the rate of isolation of cultures.²³ When calculating the incidence density of CLABSIs, the device associated infection guidelines of National Healthcare Safety network (NHSN)²⁴ endorse that we take “central-line days” as the denominator for the calculation. “Central line days” were calculated using a day-by-day count of patients on a central line who were admitted to a healthcare facility. This adjusts the risk of CLABSI with respect to the duration that the central line was in place.

Gram-negative bacteria were the most common isolates in our study, with 27 (67.5%), followed by gram-positive bacteria 13 (32.5%), which correlated with Aneta Guzeket al’s study.^25-27 whereas gram-positive cocci were the most common pathogens causing CLABSI in the Zeng C et al. study.²⁸

Among the gram-negative bacteria, carbapenemase-producing strains included Klebsiella pneumoniae (40%), Escherichia coli (62.5%), Acinetobacter baumanii (40%) and Pseudomonas aeruginosa (75%)which is co relating with other study Montrucchio, G et al study.^29,30 While 90% of Klebsiella pneumoniae, 75% of Escherichia coli, and 100% of Acinetobacter baumanii were ESBL producers, All gram-negative bacteria were sensitive to polymyxin Bwhich is co relating with other studyKhodare A et al.^31-33

Among the gram-positive cocci isolates, 66.67% of staphylococci were methicillin-resistant Staphylococcus aureus (MRSA) and 71.5% were methicillin-resistant coagulase-negative staphylococci (MR-CoNS). MRSA and MR-CoNS were both susceptible to vancomycin and linezolide; similar findings were reported in different studies.³³

Out of 40 cases of CLABSI, three patients died: one from renal failure, one from sepsis with multi-organ disorder syndrome (MODS), and two from chronic obstructive pulmonary disease.

The presence of such a resistant strain in our hospitals has grave implications. It is time to establish antibiotic surveillance systems, with each country having its own antibiotic policy and adhering to good infection control practices, including hand hygiene.³⁴ The colonisation of the catheter with organisms and the production of biofilm play an important role in the development of CLABSI-associated septicaemia and multi-organ failure.³⁵ Thereby, both central line insertion and maintenance bundle have to be followed strictly to reduce the CLABSI in intensive care units.^36,37

Active participation of clinicians in the early diagnosis of sepsis and proper collection of samples at an appropriate time for the early diagnosis of sepsis will thereby decrease morbidity and mortality associated with CLABSI.^38,39 More emphasis on teaching and education of medical and paramedical staff regarding the insertion and maintenance bundle for the central line, catheter hub care and after-wound care aids in the prevention of catheter colonisation and thus reduces CLABSI. Adequate hand hygiene is the most important preventive step for the transmission of multidrug-resistant (MDR) organisms among patients with central lines.^40-42

Limitations
Due to the small sample size confined to one hospital, our study’s ability to generalise current findings was limited. As a result, our study recommended that the study be replicated on a larger probability sample from different geographical locations.