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. 2022 Dec;12(4):504-515.
doi: 10.1007/s44197-022-00069-x. Epub 2022 Oct 5.

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

Victor Daniel Rosenthal  1   2 , Ruijie Yin  3 , Sandra Liliana Valderrama-Beltran  4 , Sandra Milena Gualtero  4 , Claudia Yaneth Linares  4 , Guadalupe Aguirre-Avalos  5 , Julio Cesar Mijangos-Méndez  5 , Miguel Ángel Ibarra-Estrada  5 , Luisa Fernanda Jimenez-Alvarez  6 , Lidia Patricia Reyes  6 , Carlos Arturo Alvarez-Moreno  6 , Maria Adelia Zuniga-Chavarria  7 , Ana Marcela Quesada-Mora  7 , Katherine Gomez  8 , Johana Alarcon  8 , Jose Millan Oñate  8 , Daisy Aguilar-De-Moros  9 , Elizabeth Castaño-Guerra  9 , Judith Córdoba  9 , Alejandro Sassoe-Gonzalez  10 , Claudia Marisol Millán-Castillo  10 , Lissette Leyva Xotlanihua  10 , Lina Alejandra Aguilar-Moreno  11 , Juan Sebastian Bravo Ojeda  11 , Ivan Felipe Gutierrez Tobar  11 , Mary Cruz Aleman-Bocanegra  12 , Clara Veronica Echazarreta-Martínez  12 , Belinda Mireya Flores-Sánchez  12 , Yuliana Andrea Cano-Medina  13 , Edwin Giovannny Chapeta-Parada  13 , Rafael Antonio Gonzalez-Niño  13 , Maria Isabel Villegas-Mota  14 , Mildred Montoya-Malváez  14 , Miguel Ángel Cortés-Vázquez  14 , Eduardo Alexandrino Medeiros  15 , Dayana Fram  15 , Daniela Vieira-Escudero  15 , Zhilin Jin  3
Affiliations

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

Victor Daniel Rosenthal et al. J Epidemiol Glob Health. 2022 Dec.

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.

Keywords: Healthcare-associated infection; Hospital infection; Intensive care unit; Mortality; Risk factors.

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Conflict of interest statement

All authors report no conflicts of interest related to this article.

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References

    1. Callahan D. "Managed care and the goals of medicine," (in Eng) J Am Geriatr Soc. 1998;46(3):385–388. doi: 10.1111/j.1532-5415.1998.tb01060.x. - DOI - PubMed
    1. Rosenthal VD. "International nosocomial infection control consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system," (in Eng) Am J Infect Control. 2016;44(6):e81–90. doi: 10.1016/j.ajic.2016.01.005. - DOI - PubMed
    1. “National Healthcare Safety Network (NHSN) Patient Safety Component Manual.” https://www.cdc.gov/nhsn/pdfs/pscmanual/pcsmanual_current.pdf. Accessed 23 Aug 2022.
    1. Rosenthal VD, et al. "Device-associated nosocomial infections in 55 intensive care units of 8 developing countries," (in Eng) Ann Intern Med. 2006;145(8):582–591. doi: 10.7326/0003-4819-145-8-200610170-00007. - DOI - PubMed
    1. Rosenthal VD, et al. "International nosocomial infection control consortium report, data summary for 2002–2007, issued January 2008," (in Eng) Am J Infect Control. 2008;36(9):627–637. doi: 10.1016/j.ajic.2008.03.003. - DOI - PubMed