Indian hospitals battle central line infections linked to mismanagement of tubes used for administering medicines and fluids

A seven-year study, covering a total of 54 private and public hospitals and 200 ICUs in India, has revealed that over 8,600 cases of severe bloodstream infections were linked to mismanagement of tubes inserted into large veins to deliver medicines and fluids, reported TOI. Conducted between 2017 and 2024, the research was led by Healthcare Associated Infection Surveillance Network and coordinated by AIIMS, New Delhi, with funding from US Centers for Disease Control and Prevention.

About 40% of patients with central line infections died within two weeks. The rate: 8.83 central line infections per 1,000 central line-days, meaning nine infections for every 1,000 days that central lines were used. The study, just out in Lancet, recorded 9,77,052 central line-days. The figures are much higher than reported in the US, where the rate even in 2020 (Covid year) was 0.87 per 1,000, according to the TOI report.

Doctors warned that newborns are highly vulnerable to infections, and the risk rises significantly when they require central lines in ICUs. A study titled ‘Profile of CLABSI (Central-Line Associated Bloodstream Infection) Infections in Adults’ found that 87% of Acinetobacter and 78% of Klebsiella infections—the two leading causes in such cases—were resistant to carbapenems, a class of last-resort antibiotics. Another major culprit was Candida auris, a drug-resistant fungal infection, which also emerged as a frequent cause. These infections typically reach central lines through contaminated hands, equipment, or medicines and then spread into the bloodstream.

“There is a haphazard use of third-line antibiotics like carbapenems because they are the most effective to a point that now they are being rendered useless. We have allowed this resistance to develop because of a lack of monitoring mechanism and guidelines,” said Dr Hemalata Arora, infectious disease expert at Mumbai’s Nanavati Hospital told TOI.

Infection coincided with COVID
The authors, microbiologists from across India, noted that infection rates peaked in 2020-21 during the Covid pandemic, when overwhelmed ICUs, staff shortages, and weakened infection-control practices likely contributed. While rates declined the following year, they rose again, leading the researchers to conclude that the problem remains persistent.

A paediatrician and infectious disease specialist from Mumbai told TOI, “In most govt and semi-govt setups, doctors as well as allied staff are overworked due to staff shortage. Very sick patients often require prolonged use of central lines, and for paediatric patients, repeated needle pricks are difficult, so central lines are kept for longer durations. But these central lines are often not managed properly because of inadequate training and understaffing.”