Original article Incidence, risk factors and microbiology of central vascular catheter- related bloodstream infection in an intensive care unit Zied Hajjej * , Mourad Nasri, Walid Sellami, Hedi Gharsallah, Iheb Labben, Mustapha Ferjani Intensive Care Unit, Military Hospital of Tunis, 1008 Montfleury, Tunis, Tunisia article info Article history: Received 13 June 2013 Received in revised form 25 August 2013 Accepted 30 August 2013 Keywords: Central vascular catheters Incidence Infection Risk factors Microbiology Intensive care unit abstract Although there are many studies about catheter related infection in industrialized countries, very few have analyzed it in emerging countries. The aim of our study was to determine the incidence, micro- biological profile and risk factors for catheter-related bloodstream infection (CRBSI) in a Tunisian medical intensive care unit. Over eight months (1 January 2012e30 August 2012) a prospective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. Two hundred sixty patients, with a total of 482 CVCs were enrolled. The mean duration of catheterization was 9.6  6.2 days. The incidence for CRBSI and catheter colonization (CC) was 2.4 and 9.3 per 1000 catheter days, respectively. Risk factors independently associated with CRBSI were diabetes mellitus, long duration of catheterization, sepsis at insertion and administration of one or more anti- biotics before insertion. The mortality rate among the CRBSI group was 21.8%. The predominant mi- croorganisms isolated from CRBSI and CC episodes were Gram negative bacilli. All Gram negative organisms isolated among dead patients in CRBSI group were Extensive Drug Resistant (XDR). In our study the mortality rate among patients with CRBSI was high despite a low incidence of CRBSI. This high rate can be explained by the high-virulent status of Gram negative bacteria involved in CRBSI. Ó 2013, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. 1. Introduction Central venous catheters (CVCs) are commonly used in the intensive care unit (ICU). Indeed, up to 80% of critically ill patients may require central venous catheterization [1]. However, use of CVCs can lead to bloodstream infection, frequently referred to as catheter-related bloodstream infection (CRBSI). Such infections are associated with serious morbidity and mortality and with increased health care costs [2]. Despite the large number of published studies on Catheter-related infections (CRI), the data from intensive care units of emerging countries are few. Limited resources in these countries impose strict monitoring of nosocomial infections, in particular CRI. The aim of our study was to determine the incidence, microbiological profile and risk factors for CRBSI in a Tunisian medical intensive care unit. 2. Materials and methods 2.1. Patients and data collection Over eight months (1 January 2012e30 August 2012) a pro- spective, observational study was performed in an 18-bed medical surgical intensive care unit at Tunis military hospital. The approval of the ethics committee was not necessary given the strictly observational nature of the study. Patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. If a patient had more than one CVC inserted during the ICU stay, each CVC inserted that met the inclusion criteria was enrolled. The catheters used were multi-lumen, made of polyurethane and not antibiotic-impregnated. The placement and maintenance of catheters were performed according to the following protocol. The catheters were inserted by physicians with sterile-barrier precautions: use of sterile full body drapes around the insertion site, surgical antiseptic hand wash, and sterile gown, gloves, mask and cap. The skin insertion site was disinfected with 10% povidoneeiodine. The catheters were percu- taneously inserted using the Seldinger technique and were fixed to * Corresponding author. Tel.: þ216 71 391 133; fax: þ216 71 391 099. E-mail addresses: hajjej_zied@hotmail.com (Z. Hajjej), nasrimourad80@yahoo.fr (M. Nasri), drsellamiwalid@yahoo.fr (W. Sellami), gharsallahhedi@yahoo.fr (H. Gharsallah), iheb1labbene@yahoo.fr (I. Labben), mustapha.ferjani@planet.tn (M. Ferjani). Contents lists available at ScienceDirect Journal of Infection and Chemotherapy journal homepage: http://www.elsevier.com/locate/jic 1341-321X/$ e see front matter Ó 2013, Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jiac.2013.08.001 J Infect Chemother 20 (2014) 163e168