The impact of healthcare-associated infections on mortality in ICU: A prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East
Background: The International Nosocomial Infection Control Consortium has found a high ICU mortality rate. Our aim was to identify all-cause mortality risk factors in ICU-patients.
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.
Rosenthal VD, Yin R, Lu Y, Rodrigues C, Myatra SN, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Daboor MA, Todi SK, Aguirre-Avalos G, Guclu E, Gan CS, Jiménez-Alvarez LF, Chawla R, Hlinkova S, Arjun R, Agha HM, Zuniga-Chavarria MA, Davaadagva N, Basri MNM, Gomez-Nieto K, Aguilar-de-Moros D, Tai CW, Sassoe-Gonzalez A, Aguilar-Moreno LA, Sandhu K, Janc J, Aleman-Bocanegra MC, Yildizdas D, Cano-Medina YA, Villegas-Mota MI, Omar AA, Duszynska W, BelKebir S, El-Kholy AA, Alkhawaja SA, Florin GH, Medeiros EA, Tao L, Memish ZA, Jin Z. The impact of healthcare-associated infections on mortality in ICU: A prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East. Am J Infect Control. 2022 Sep 6:S0196-6553(22)00658-7. doi: 10.1016/j.ajic.2022.08.024. Epub ahead of print. PMID: 36075294.