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.

Autor: Rosenthal VD; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA. victor_rosenthal@inicc.org.; INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA. victor_rosenthal@inicc.org., Yin R; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA., Valderrama-Beltran SL; Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia., Gualtero SM; Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia., Linares CY; Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia., Aguirre-Avalos G; Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico., Mijangos-Méndez JC; Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico., Ibarra-Estrada MÁ; Hospital Civil de Guadalajara Fray Antonio Alcalde, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico., Jimenez-Alvarez LF; Clinica Universitaria Colombia, Bogota, Colombia., Reyes LP; Clinica Universitaria Colombia, Bogota, Colombia., Alvarez-Moreno CA; Clinica Universitaria Colombia, Bogota, Colombia., Zuniga-Chavarria MA; Hospital Clinica Biblica, San José, Costa Rica., Quesada-Mora AM; Hospital Clinica Biblica, San José, Costa Rica., Gomez K; Clinica Sebastian de Belalcazar, Cali, Colombia., Alarcon J; Clinica Sebastian de Belalcazar, Cali, Colombia., Oñate JM; Clinica Sebastian de Belalcazar, Cali, Colombia., Aguilar-De-Moros D; Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama., Castaño-Guerra E; Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama., Córdoba J; Hospital del Nino Dr Jose Renan Esquivel, Panama, Panama., Sassoe-Gonzalez A; Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico., Millán-Castillo CM; Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico., Xotlanihua LL; Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico., Aguilar-Moreno LA; Clinica Infantil Santa Maria del Lago, Bogota, Colombia., Ojeda JSB; Clinica Infantil Santa Maria del Lago, Bogota, Colombia., Tobar IFG; Clinica Infantil Santa Maria del Lago, Bogota, Colombia., Aleman-Bocanegra MC; Hospital San Jose TecSalud, Monterrey, Nuevo Leon, Mexico., Echazarreta-Martínez CV; Hospital San Jose TecSalud, Monterrey, Nuevo Leon, Mexico., Flores-Sánchez BM; Hospital San Jose TecSalud, Monterrey, Nuevo Leon, Mexico., Cano-Medina YA; Instituto del Corazon de Bucaramanga Sede Bogota, Bogota, Colombia., Chapeta-Parada EG; Instituto del Corazon de Bucaramanga Sede Bogota, Bogota, Colombia., Gonzalez-Niño RA; Instituto del Corazon de Bucaramanga Sede Bogota, Bogota, Colombia., Villegas-Mota MI; Instituto Nacional de Perinatologia, Mexico City, Mexico., Montoya-Malváez M; Instituto Nacional de Perinatologia, Mexico City, Mexico., Cortés-Vázquez MÁ; Instituto Nacional de Perinatologia, Mexico City, Mexico., Medeiros EA; Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil., Fram D; Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil., Vieira-Escudero D; Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil., Jin Z; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk: angličtina
Zdroj: Journal of epidemiology and global health [J Epidemiol Glob Health] 2022 Dec; Vol. 12 (4), pp. 504-515. Date of Electronic Publication: 2022 Oct 05.
DOI: 10.1007/s44197-022-00069-x
Abstrakt: 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.
(© 2022. The Author(s).)
Databáze: MEDLINE
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