The impact of healthcare-associated infections on mortality in ICU: a prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East

• Main Authors: 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, Mat Nor, Mohd Basri, Gomez-Nieto, Katherine, Aguilar-de-Moros, Daisy, Tai, Chian-Wern, Sassoe-Gonzalez, Alejandro
• Format: Article
• Language: English; English
• Published: Elsevier 2023
• Subjects: RC82 Medical Emergencies, Critical Care, Intensive Care, First Aid
• Online Access: http://irep.iium.edu.my/115450/7/115450_The%20impact%20of%20healthcare-associated%20infections%20on%20mortality%20in%20ICU.pdf; http://irep.iium.edu.my/115450/8/115450_The%20impact%20of%20healthcare-associated%20infections%20on%20mortality%20in%20ICU_Scopus.pdf; http://irep.iium.edu.my/115450/; https://www.ajicjournal.org/article/S0196-6553(22)00658-7/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 (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 MVutilization, and use evidence-based recommendations to prevent HAIs.