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The Impact of Healthcare-Associated Infections on Mortality in ICU: A Prospective Study in Asia, Eastern Europe, Latin America, and the Middle East

Published:September 05, 2022DOI:https://doi.org/10.1016/j.ajic.2022.08.024

      Abstract

      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 (CLABSI) (aOR:1.84; p<0.0001); ventilator-associated pneumonia (VAP) (aOR:1.48; p<0.0001); catheter-associated urinary tract infection (CAUTI) (aOR:1.18;p<0.0001); medical hospitalization (aOR:1.81; p<0.0001); length of stay (LOS), risk rises 1% per day (aOR:1.01; p<0.0001); female gender (aOR:1.09; p<0.0001); age (aOR:1.012; p<0.0001); central line-days, risk rises 2% per day (aOR:1.02; p<0.0001); and mechanical ventilator (MV)-utilization ratio (aOR:10.46; p<0.0001). Coronary ICU showed the lowest risk for mortality (aOR: 0.34;p<0.0001).

      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; CLABSI, VAP, CAUTI, 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.

      Keywords

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