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
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 analyze...
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Published in | Journal of Epidemiology and Global Health Vol. 12; no. 4; pp. 504 - 515 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Dordrecht
Springer Netherlands
01.12.2022
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Abstract | 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. |
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AbstractList | The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America.
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.
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.
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. 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. |
Author | Reyes, Lidia Patricia Yin, Ruijie Quesada-Mora, Ana Marcela Córdoba, Judith Xotlanihua, Lissette Leyva Flores-Sánchez, Belinda Mireya Aguilar-De-Moros, Daisy Cano-Medina, Yuliana Andrea Rosenthal, Victor Daniel Villegas-Mota, Maria Isabel Mijangos-Méndez, Julio Cesar Alarcon, Johana Aguilar-Moreno, Lina Alejandra Montoya-Malváez, Mildred Gomez, Katherine Fram, Dayana Millán-Castillo, Claudia Marisol Aleman-Bocanegra, Mary Cruz Jimenez-Alvarez, Luisa Fernanda Vieira-Escudero, Daniela Aguirre-Avalos, Guadalupe Ojeda, Juan Sebastian Bravo Valderrama-Beltran, Sandra Liliana Ibarra-Estrada, Miguel Ángel Gonzalez-Niño, Rafael Antonio Tobar, Ivan Felipe Gutierrez Jin, Zhilin Sassoe-Gonzalez, Alejandro Alvarez-Moreno, Carlos Arturo Oñate, Jose Millan Castaño-Guerra, Elizabeth Medeiros, Eduardo Alexandrino Gualtero, Sandra Milena Echazarreta-Martínez, Clara Veronica Cortés-Vázquez, Miguel Ángel Zuniga-Chavarria, Maria Adelia Linares, Claudia Yaneth Chapeta-Parada, Edwin Giovannny |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36197596$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1093_ofid_ofad129 crossref_primary_10_1186_s13613_023_01146_5 crossref_primary_10_1016_j_ajic_2023_07_007 crossref_primary_10_1017_ice_2023_215 crossref_primary_10_1007_s00345_023_04645_z crossref_primary_10_1016_j_ajic_2023_12_019 |
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Keywords | Hospital infection Healthcare-associated infection Mortality Risk factors Intensive care unit |
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Snippet | Background
The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America.
Methods
A prospective cohort... The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. A prospective cohort study in 198 ICUs... |
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SubjectTerms | 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 |
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Title | 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 |
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