Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections

• Published in: Journal of Epidemiology and Global Health Vol. 12; no. 4; pp. 504 - 515
• Main Authors: Rosenthal, Victor Daniel, Yin, Ruijie, Valderrama-Beltran, Sandra Liliana, Gualtero, Sandra Milena, Linares, Claudia Yaneth, Aguirre-Avalos, Guadalupe, Mijangos-Méndez, Julio Cesar, Ibarra-Estrada, Miguel Ángel, Jimenez-Alvarez, Luisa Fernanda, Reyes, Lidia Patricia, Alvarez-Moreno, Carlos Arturo, Zuniga-Chavarria, Maria Adelia, Quesada-Mora, Ana Marcela, Gomez, Katherine, Alarcon, Johana, Oñate, Jose Millan, Aguilar-De-Moros, Daisy, Castaño-Guerra, Elizabeth, Córdoba, Judith, Sassoe-Gonzalez, Alejandro, Millán-Castillo, Claudia Marisol, Xotlanihua, Lissette Leyva, Aguilar-Moreno, Lina Alejandra, Ojeda, Juan Sebastian Bravo, Tobar, Ivan Felipe Gutierrez, Aleman-Bocanegra, Mary Cruz, Echazarreta-Martínez, Clara Veronica, Flores-Sánchez, Belinda Mireya, Cano-Medina, Yuliana Andrea, Chapeta-Parada, Edwin Giovannny, Gonzalez-Niño, Rafael Antonio, Villegas-Mota, Maria Isabel, Montoya-Malváez, Mildred, Cortés-Vázquez, Miguel Ángel, Medeiros, Eduardo Alexandrino, Fram, Dayana, Vieira-Escudero, Daniela, Jin, Zhilin
• Format: Journal Article
• Language: English
• Published: Dordrecht Springer Netherlands 01.12.2022
• Subjects: Adult; Catheter-Related Infections; Cross Infection - epidemiology; Delivery of Health Care; Humans; Intensive Care Units; Latin America - epidemiology; Medicine; Medicine & Public Health; Prospective Studies; Research Article; Risk Factors; Urinary Tract Infections; Latin America; Hospital infection; Healthcare-associated infection; Mortality; Risk factors; Intensive care unit
• ISSN: 2210-6006; 2210-6014
• DOI: 10.1007/s44197-022-00069-x

Background The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. Methods A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. Results Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06–1.30; p  < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15–1.56; p  < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01–1.02; p  < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02–1.03; p  < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01–1.26; p  < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96–7.03; p  < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11–1.27; p  < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10–4.12; p  < 0.0001); private (aOR = 1.50; 95% CI: 1.27–1.77; p  < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24–1.74; p  < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59–1.75; p  < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68–7.50; p  < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14–5.65; p  < 0.0001); and others. Conclusion Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.