Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections.

Autor: Rosenthal VD; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; International Nosocomial Infection Control Consortium, Miami, FL, USA. Electronic address: victor_rosenthal@inicc.org., Jin Z; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA., Memish ZA; King Saud Medical City, Ministry of Health, Riyadh, Saudi Arabia., Daboor MA; King Hussein Cancer Center, Amman, Jordan., Al-Ruzzieh MA; King Hussein Cancer Center, Amman, Jordan., Hussien NH; King Hussein Cancer Center, Amman, Jordan., Guclu E; Sakarya University Training and Research Hospital, Sakarya, Turkey., Olmez-Gazioglu E; Sakarya University Training and Research Hospital, Sakarya, Turkey., Ogutlu A; Sakarya University Training and Research Hospital, Sakarya, Turkey., Agha HM; Cairo University Specialized Pediatric Hospital, Cairo, Egypt., El-Sisi A; Cairo University Specialized Pediatric Hospital, Cairo, Egypt., Fathalla AA; Cairo University Specialized Pediatric Hospital, Cairo, Egypt., Yildizdas D; Cukurova University, Balcali Hospital, Adana, Turkey., Yildizdas HY; Cukurova University, Balcali Hospital, Adana, Turkey., Ozlu F; Cukurova University, Balcali Hospital, Adana, Turkey., Horoz OO; Cukurova University, Balcali Hospital, Adana, Turkey., Omar AA; Infection Control Directorate, Ministry of Health, Kuwait City, Kuwait., Belkebir S; An Najah National University, Nablus, Palestine., Kanaa A; An Najah National University, Nablus, Palestine., Jeetawi R; An Najah National University, Nablus, Palestine., El-Kholy AA; Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt., Bayani V; Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt., Alwakil W; Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt., Abdulaziz-Alkhawaja S; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Dar Alfouad Hospital, 6th of October City, 6th of October City, Egypt., Swar SF; Salmaniya Medical Center, Manama, Bahrain., Magray TA; Salmaniya Medical Center, Manama, Bahrain., Alsayegh AA; Salmaniya Medical Center, Manama, Bahrain., Yin R; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk: angličtina
Zdroj: Journal of critical care [J Crit Care] 2022 Dec; Vol. 72, pp. 154149. Date of Electronic Publication: 2022 Sep 13.
DOI: 10.1016/j.jcrc.2022.154149
Abstrakt: Purpose: The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME.
Materials: From 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression.
Results: 66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001).
Conclusion: Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.
Competing Interests: Declaration of Competing Interest All authors report no conflicts of interest related to this article. The Institutional Review Board of each hospital agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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