Multinational prospective study of incidence and risk factors for central line-associated bloodstream infections in 728 ICUs of 41 Asian, African, Eastern European, Latin American and Middle Eastern countries over 24 years
Objective: Identify central line (CL)-associated bloodstream infections (CLABSI) incidence and risk factors (RF) in low and middle-income countries (LMIC).
Design: From 07/01/1998 to 02/12/2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms.
Setting: 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern-European, Latin-American, and Middle-Eastern countries.
Patients: 278,241 patients, followed during 1,815,043 patient-days, acquired 3,537 CLABSIs.
Methods: The CLABSI rate had CL-days as denominators and the number of CLABSIs as numerators. Using multiple logistic regression outcomes are shown as adjusted odds ratios (aOR).
Results: Pooled CLABSI rates is 4.82 CLABSI per 1,000 CL-days, significantly higher than the CDC NHSN. We analyzed 11 variables, and following variables were independently significantly associated with CLABSI: Length of stay (LOS), rising risk 3% daily (aOR=1.03;95%CI=1.03-1.04;p<0.0001), number of CL-days, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.04;p<0.0001), surgical hospitalization (aOR=1.12;95%CI=1.03-1.21;p<0.0001), tracheostomy use (aOR=1.52;95%CI=1.23-1.88;p<0.0001), hospitalized at a publicly-owned facility (aOR=3.04;95%CI=2.31-4.01;p<0.0001) or at a teaching-hospital (aOR=2.91;95%CI=2.22-3.83;p<0.0001), located at a middle-income country (aOR=2.41;95%CI=2.09-2.77;p<0.0001). ICU with highest risk was adult-oncology (aOR=4.35;95%CI=3.11-6.09;p<0.0001), followed by pediatric-oncology (aOR=2.51;95%CI=1.57-3.99;p<0.0001), and pediatric (aOR=2.34;95%CI=1.81-3.01;p<0.0001) ICU. CL with the highest risk was internal-jugular (aOR=3.01;95%CI=2.71-3.33;p<0.0001), followed by femoral (aOR=2.29;95%CI=1.96-2.68;p<0.0001). PICC (aOR=1.48;95%CI=1.02-2.18;p=0.04) was the CL with the lowest CLABSI risk.
Conclusions: The following CLABSI RFs are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, and tracheostomy; using PICC instead of internal-jugular or femoral; and implementing evidence-based CLABSI prevention recommendations.
Title: Rosenthal VD, Ruijie Yin, Sheila Nainan Myatra, Ziad A. Memish, Camilla Rodrigues, Mohit Kharbanda, Sandra Liliana Valderrama-Beltran, Yatin Mehta, Majeda Afeef Al-Ruzzieh, Guadalupe Aguirre-Avalos, Ertugrul Guclu, Chin Seng Gan, Luisa Fernanda Jiménez Alvarez, Rajesh Chawla, Sona Hlinkova, Rajalakshmi Arjun, Hala Mounir Agha, Maria Adelia Zuniga Chavarria, Narangarav Davaadagva, Yin Hoong Lai, Katherine Gomez, Daisy Aguilar De Moros, Chian-Wern Tai, Alejandro Sassoe Gonzalez, Lina Alejandra Aguilar Moreno, Kavita Sandhu, Jarosław Janc, Mary Cruz Aleman Bocanegra, Dincer Yildizdas, Yuliana Andrea Cano Medina, Maria Isabel Villegas Mota, Abeer Aly Omar, Wieslawa Duszynska, Amani Ali El-Kholy, Safaa Abdulaziz Alkhawaja, George Horhat Florin, Eduardo Alexandrino Medeiros, Lili Tao, Nellie Tumu, May Gamar Elanbya, Reshma Dongol, Vesna Mioljević, Lul Raka. Lourdes Dueñas, Nilton Yhuri Carreazo, Tarek Dendane, Aamer Ikram, Tala Kardas, Michael M. Petrov, Asma Bouziri, Nguyen Viet Hung, Vladislav Belskiy, Naheed Elahi, Estuardo Salgado. Multinational prospective study of incidence and risk factors for central line-associated bloodstream infections in 728 ICUs of 41 Asian, African, Eastern European, Latin American and Middle Eastern countries over 24 years. Infection Control And Hospital Epidemiology. Accepted for publication and in Press. 2023.