Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections over 18 years in 281 ICUs of 9 Asian countries.

Autor:	Rosenthal VD; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.; International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, FL, USA., Yin R; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA., Rodrigues C; Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India., Myatra SN; Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India., Divatia JV; Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India., Biswas SK; Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India., Shrivastava AM; Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India., Kharbanda M; Department of Critical Care, Desun Hospital, Kolkata, India., Nag B; Department of Critical Care, Desun Hospital, Kolkata, India., Mehta Y; Department of Critical Care and Anesthesiology, Medanta The Medicity, Haryana, India., Sarma S; Department of Critical Care and Anesthesiology, Medanta The Medicity, Haryana, India., Todi SK; Department of Critical Care, Advanced Medicare Research Institute AMRI Hospitals, Kolkata, India., Bhattacharyya M; Department of Critical Care, Advanced Medicare Research Institute AMRI Hospitals, Kolkata, India., Bhakta A; Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Gan CS; Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Low MSY; Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Bt Madzlan Kushairi M; Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Chuah SL; Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Wang QY; Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia., Chawla R; Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India., Jain AC; Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India., Kansal S; Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India., Bali RK; Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India., Arjun R; Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India., Davaadagva N; Intermed Hospital, Ulaanbaatar, Mongolia., Bat-Erdene I; Intermed Hospital, Ulaanbaatar, Mongolia., Begzjav T; Intermed Hospital, Ulaanbaatar, Mongolia., Mohd Basri MN; Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia., Tai CW; Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia., Lee PC; Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia., Tang SF; Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia., Sandhu K; Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India., Badyal B; Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India., Arora A; Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India., Sengupta D; Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India., Tao L; Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China., Jin Z; Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA.
Jazyk:	angličtina
Zdroj:	The journal of vascular access [J Vasc Access] 2024 Sep; Vol. 25 (5), pp. 1508-1518. Date of Electronic Publication: 2023 May 07.
DOI:	10.1177/11297298231169542
Abstrakt:	Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors (RF) in Asia. Methods: From 03/27/2004 to 02/11/2022, we conducted a multinational multicenter prospective cohort study in 281 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam). For estimation of CLABSI rate we used CL-days as denominator and number of CLABSI as numerator. To estimate CLABSI RF for we analyzed the data using multiple logistic regression, and outcomes are shown as adjusted odds ratios (aOR). Results: A total of 150,142 patients, hospitalized 853,604 days, acquired 1514 CLABSIs. Pooled CLABSI rate per 1000 CL-days was 5.08; per type of catheter were: femoral: 6.23; temporary hemodialysis: 4.08; jugular: 4.01; arterial: 3.14; PICC: 2.47; subclavian: 2.02. The highest rates were femoral, temporary for hemodialysis, and jugular, and the lowest PICC and subclavian. We analyzed following variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization ratio, CL-type, tracheostomy use, hospitalization type, ICU type, facility ownership and World Bank classifications by income level. Following were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 4% daily (aOR = 1.04; 95% CI = 1.03-1.04; p  < 0.0001); number of CL-days before CLABSI acquisition, rising risk 5% per CL-day (aOR = 1.05; 95% CI 1.05-1.06; p  < 0.0001); medical hospitalization (aOR = 1.21; 95% CI 1.04-1.39; p  = 0.01); tracheostomy use (aOR = 2.02;95% CI 1.43-2.86; p  < 0.0001); publicly-owned facility (aOR = 3.63; 95% CI 2.54-5.18; p  < 0.0001); lower-middle-income country (aOR = 1.87; 95% CI 1.41-2.47; p  < 0.0001). ICU with highest risk was pediatric (aOR = 2.86; 95% CI 1.71-4.82; p  < 0.0001), followed by medical-surgical (aOR = 2.46; 95% CI 1.62-3.75; p  < 0.0001). CL with the highest risk were internal-jugular (aOR = 3.32; 95% CI 2.84-3.88; p  < 0.0001), and femoral (aOR = 3.13; 95% CI 2.48-3.95; p  < 0.0001), and subclavian (aOR = 1.78; 95% CI 1.47-2.15; p  < 0.0001) showed the lowest risk. Conclusions: The following CLABSI RFs are unlikely to change: country income level, facility-ownership, hospitalization type, and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, and tracheostomy; using subclavian or PICC instead of internal-jugular or femoral; and implementing evidence-based CLABSI prevention recommendations. Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: All authors declare that don’t have any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work. All authors declare that don’t have potential competing interests, such as employment, consultancies, stock ownership, honoraria, paid expert testimony, patent applications/registrations, and grants or other funding. Submission of this article implies that the work described has not been published previously, that it is not under consideration for publication elsewhere, that its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out, and that, if accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder.
Databáze:	MEDLINE
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