The prevalence of central venous catheter associated infections at the intensive care unit of Kenyatta National Hospital
Abstract
Central venous catheters are important in the management of critical care patients, but
the major pitfall is their contribution to nosocomial infections which are an important
cause of morbidity and mortality.
The study was conducted in K.N.H critical care unit (combined surgical and medical),
a hundred patients with age ranging from 7 to 80 years were studied 52 being male and
48 female. The diagnoses were categorized into infectious, non infectious and trauma.
The prevalence of Catheter related blood-stream infections was 12% (95% C.I 5.6 to
18.36%). Central venous catheter tip colonisation prevalence being 13%. The majority of
organisms qualifying for CRBI were gram negative organisms (10 out of 12), the leading
one being klebsiella pneumoniae. The study did not show significant difference in gender
predisposition towards Catheter related blood-stream infections. Patients older than 40
years showed greater predisposition to Catheter related blood-stream infections with 50%
of the CRBI being in this category.
Previous and current antibiotic use did not influence occurrence of catheter related
infections. In this study steroids, blood and blood-products and parenteral nutrition were
not statistically shown to influence occurrence of bloodstream infections. Occurrence of
signs of sepsis did not indicate occurrence of Catheter related blood-stream infections.
The level of blood sugar and packed cell volume also did not influence occurrence of
Catheter related blood-stream infections while renal and hepatic organ impairment were a
predisposition. However respiratory and urinary tract infections did not put patients at
risk of catheter related bloodstream infections.
The gram positive organisms identified (staphylococcus aureus and epidermidis) were
sensitive to Linezolid, Vancomycin, Gentamycin and Clindamycin. They were resistant
to Augmentin, Cefuroxime and others.
On the other hand gram negative organisms were sensitive to Imipenem, Meropenem,
Amikacin, Tazocin-piperacillin and Cefepime. Resistance was shown to Augmentin,
Nalidixic acid, Doxycyline and Ampicillin. Varying patterns of resistance were shown to
the other antibiotics.
The only fungus grown was candida albicans and this showed no resistance to the
common antifungals tested.
Citation
Degree of Masters of Medicine in Anaesthesia, University of Nairobi.Publisher
University of Nairobi School of Medicine
Description
A dissertation submitted in part fulfillment of the requirements for the
award of the Degree of Master of medicine in Anaesthesia of the
University of Nairobi