The impact of healthcare-associated infections on mortality in ICU: A prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East.
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Rosenthal Victor Daniel, Yin Ruijie, Lu Yawen, Rodrigues Camilla, Myatra Sheila Nainan, Kharbanda Mohit, Valderrama-Beltran Sandra Liliana, Mehta Yatin, Daboor Mohammad Abdellatif, Todi Subhash Kumar, Aguirre-Avalos Guadalupe, Guclu Ertugrul, Gan Chin Seng, Jiménez-Alvarez Luisa Fernanda, Chawla Rajesh, Hlinkova Sona, Arjun Rajalakshmi, Agha Hala Mounir, Zuniga-Chavarria Maria Adelia, Davaadagva Narangarav, Basri Mat Nor Mohd, Gomez-Nieto Katherine, Aguilar-de-Moros Daisy, Tai Chian-Wern, Sassoe-Gonzalez Alejandro, Aguilar-Moreno Lina Alejandra, Sandhu Kavita, Janc Jarosław, Aleman-Bocanegra Mary Cruz, Yildizdas Dincer, Cano-Medina Yuliana Andrea, Villegas-Mota Maria Isabel, Omar Abeer Aly, Duszynska Wieslawa, BelKebir Souad, El-Kholy Amani Ali, Alkhawaja Safaa Abdulaziz, Florin George Horhat, Medeiros Eduardo Alexandrino, Tao Lili, Memish Ziad A, Jin Zhilin
Аннотация
METHODS: Multinational, multicenter, prospective cohort study at 786 ICUs of 312 hospitals in 147 cities in 37 Latin American, Asian, African, Middle Eastern, and European countries.
RESULTS: Between 07/01/1998 and 02/12/2022, 300,827 patients, followed during 2,167,397 patient-days, acquired 21,371 HAIs. Following mortality risk factors were identified in multiple logistic regression: Central line-associated bloodstream infection (aOR:1.84; P<.0001); ventilator-associated pneumonia (aOR:1.48; P<.0001); catheter-associated urinary tract infection (aOR:1.18;P<.0001); medical hospitalization (aOR:1.81; P<.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; P<.0001); female gender (aOR:1.09; P<.0001); age (aOR:1.012; P<.0001); central line-days, risk rises 2% per day (aOR:1.02; P<.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; P<.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34;P<.0001).
CONCLUSION: Some identified risk factors are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; Central line-associated bloodstream infection, ventilator-associated pneumonia, catheter-associated urinary tract infection, LOS, and MV-utilization. So, to lower the risk of death in ICUs, we recommend focusing on strategies to shorten the LOS, reduce MV-utilization, and use evidence-based recommendations to prevent HAIs.