Antimicrobial resistance profiles and mortality rates in intensive care unit patients having central line associated blood stream infection: a temporal analysis

Background: Patients with indwelling devices in the intensive care unit (ICU) face a heightened risk of infections, particularly central-line associated blood stream infection (CLABSI). With the aim of enhancing ICU prevention strategies, this study assessed CLABSI incidence, key pathogens, and their resistence profiles. Method: The retrospective study analyzed patients with central line catheter (CLC) from 2021 to 2023. Patients’ demographic details, CLC site, ICU stay, and blood culture reports including resistance were analyzed. Results: Among 3,761 patients, CLABSI incidence rates were 6.18 (n=18, 2021), 1.69 (n=15, 2022), and 3.75 (n=42, 2023) per 1,000 CL days. The predominant GNB included Klebsiella pneumoniae (25.3%), Acinetobacter baumannii (16%), and Pseudomonas aeruginosa (9.33%), while GPC included Enterococcus species (5.33%) and Staphylococcus aureus (2.66%). Klebsiella (K.) pneumoniae and Pseudomonas (P.) aeruginosa exhibited rising resistance to cephalosporins, carbapenems, BL-BLIs, and monobactams. Acinetobacter (A.) baumannii showed decreased resistance to carbapenems and BL-BLIs. Staphylococcus (S.) aureus exhibited decreased resistance to macrolides and lincosamides, while Enterococcus species showed increased resistance to macrolides and penicillin. Candida species (21.3%) were isolated in 2022, with one case of Candida auris in 2023. Multidrug-resistant (MDR) CLABSIs had statistically significantly higher mortality (p=0.042). Discussion: GNB showed increased resistance to cephalosporins, carbapenems, and BL-BLIs. In contrast, S. aureus demonstrated decreased resistance to lincosamides, while Enterococcus showed rising resistance to macrolides and penicillin, raising concern about treatment. Conclusion: These findings emphasize the urgent need for targeted stewardship against CLABSI.