2 results
Incidence and risk factors for catheter-associated urinary tract infection in 623 intensive care units throughout 37 Asian, African, Eastern European, Latin American, and Middle Eastern nations: A multinational prospective research of INICC
- Victor Daniel Rosenthal, Ruijie Yin, Eric Christopher Brown, Brandon Hochahn Lee, Camilla Rodrigues, Sheila Nainan Myatra, Mohit Kharbanda, Prasad Rajhans, Yatin Mehta, Subhash Kumar Todi, Sushmita Basu, Suneeta Sahu, Shakti Bedanta Mishra, Rajesh Chawla, Pravin K. Nair, Rajalakshmi Arjun, Deepak Singla, Kavita Sandhu, Vijayanand Palaniswamy, Arpita Bhakta, Mohd-Basri Mat Nor, Tai Chian-Wern, Ider Bat-Erdene, Subhash P. Acharya, Aamer Ikram, Nellie Tumu, Lili Tao, Gustavo Andres Alvarez, Sandra Liliana Valderrama-Beltran, Luisa Fernanda Jiménez-Alvarez, Claudia Milena Henao-Rodas, Katherine Gomez, Lina Alejandra Aguilar-Moreno, Yuliana Andrea Cano-Medina, Maria Adelia Zuniga-Chavarria, Guadalupe Aguirre-Avalos, Alejandro Sassoe-Gonzalez, Mary Cruz Aleman-Bocanegra, Blanca Estela Hernandez-Chena, Maria Isabel Villegas-Mota, Daisy Aguilar-de-Moros, Alex Castañeda-Sabogal, Eduardo Alexandrino Medeiros, Lourdes Dueñas, Nilton Yhuri Carreazo, Estuardo Salgado, Safaa Abdulaziz-Alkhawaja, Hala Mounir Agha, Amani Ali El-Kholy, Mohammad Abdellatif Daboor, Ertugrul Guclu, Oguz Dursun, Iftihar Koksal, Merve Havan, Suna Secil Ozturk-Deniz, Dincer Yildizdas, Emel Okulu, Abeer Aly Omar, Ziad A. Memish, Jarosław Janc, Sona Hlinkova, Wieslawa Duszynska, George Horhat-Florin, Lul Raka, Michael M. Petrov, Zhilin Jin
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 45 / Issue 5 / May 2024
- Published online by Cambridge University Press:
- 04 January 2024, pp. 567-575
- Print publication:
- May 2024
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Objective:
To identify urinary catheter (UC)–associated urinary tract infection (CAUTI) incidence and risk factors.
Design:A prospective cohort study.
Setting:The study was conducted across 623 ICUs of 224 hospitals in 114 cities in 37 African, Asian, Eastern European, Latin American, and Middle Eastern countries.
Participants:The study included 169,036 patients, hospitalized for 1,166,593 patient days.
Methods:Data collection took place from January 1, 2014, to February 12, 2022. We identified CAUTI rates per 1,000 UC days and UC device utilization (DU) ratios stratified by country, by ICU type, by facility ownership type, by World Bank country classification by income level, and by UC type. To estimate CAUTI risk factors, we analyzed 11 variables using multiple logistic regression.
Results:Participant patients acquired 2,010 CAUTIs. The pooled CAUTI rate was 2.83 per 1,000 UC days. The highest CAUTI rate was associated with the use of suprapubic catheters (3.93 CAUTIs per 1,000 UC days); with patients hospitalized in Eastern Europe (14.03) and in Asia (6.28); with patients hospitalized in trauma (7.97), neurologic (6.28), and neurosurgical ICUs (4.95); with patients hospitalized in lower–middle-income countries (3.05); and with patients in public hospitals (5.89).
The following variables were independently associated with CAUTI: Age (adjusted odds ratio [aOR], 1.01; P < .0001), female sex (aOR, 1.39; P < .0001), length of stay (LOS) before CAUTI-acquisition (aOR, 1.05; P < .0001), UC DU ratio (aOR, 1.09; P < .0001), public facilities (aOR, 2.24; P < .0001), and neurologic ICUs (aOR, 11.49; P < .0001).
Conclusions:CAUTI rates are higher in patients with suprapubic catheters, in middle-income countries, in public hospitals, in trauma and neurologic ICUs, and in Eastern European and Asian facilities.
Based on findings regarding risk factors for CAUTI, focus on reducing LOS and UC utilization is warranted, as well as implementing evidence-based CAUTI-prevention recommendations.
Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections
- Victor Daniel Rosenthal, Zhilin Jin, Camilla Rodrigues, Sheila Nainan Myatra, Jigeeshu Vasishth Divatia, Sanjay K. Biswas, Anjana Mahesh Shrivastava, Mohit Kharbanda, Bikas Nag, Yatin Mehta, Smita Sarma, Subhash Kumar Todi, Mahuya Bhattacharyya, Arpita Bhakta, Chin Seng Gan, Michelle Siu Yee Low, Marissa Bt Madzlan Kushairi, Soo Lin Chuah, Qi Yuee Wang, Rajesh Chawla, Aakanksha Chawla Jain, Sudha Kansal, Roseleen Kaur Bali, Rajalakshmi Arjun, Narangarav Davaadagva, Batsuren Bat-Erdene, Tsolmon Begzjav, Mat Nor Mohd Basri, Chian-Wern Tai, Pei-Chuen Lee, Swee-Fong Tang, Kavita Sandhu, Binesh Badyal, Ankush Arora, Deep Sengupta, Ruijie Yin
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 8 / August 2023
- Published online by Cambridge University Press:
- 24 October 2022, pp. 1261-1266
- Print publication:
- August 2023
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Objective:
To identify risk factors for mortality in intensive care units (ICUs) in Asia.
Design:Prospective cohort study.
Setting:The study included 317 ICUs of 96 hospitals in 44 cities in 9 countries of Asia: China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam.
Participants:Patients aged >18 years admitted to ICUs.
Results:In total, 157,667 patients were followed during 957,517 patient days, and 8,157 HAIs occurred. In multiple logistic regression, the following variables were associated with an increased mortality risk: central-line–associated bloodstream infection (CLABSI; aOR, 2.36; P < .0001), ventilator-associated event (VAE; aOR, 1.51; P < .0001), catheter-associated urinary tract infection (CAUTI; aOR, 1.04; P < .0001), and female sex (aOR, 1.06; P < .0001). Older age increased mortality risk by 1% per year (aOR, 1.01; P < .0001). Length of stay (LOS) increased mortality risk by 1% per bed day (aOR, 1.01; P < .0001). Central-line days increased mortality risk by 2% per central-line day (aOR, 1.02; P < .0001). Urinary catheter days increased mortality risk by 4% per urinary catheter day (aOR, 1.04; P < .0001). The highest mortality risks were associated with mechanical ventilation utilization ratio (aOR, 12.48; P < .0001), upper middle-income country (aOR, 1.09; P = .033), surgical hospitalization (aOR, 2.17; P < .0001), pediatric oncology ICU (aOR, 9.90; P < .0001), and adult oncology ICU (aOR, 4.52; P < .0001). Patients at university hospitals had the lowest mortality risk (aOR, 0.61; P < .0001).
Conclusions:Some variables associated with an increased mortality risk are unlikely to change, such as age, sex, national economy, hospitalization type, and ICU type. Some other variables can be modified, such as LOS, central-line use, urinary catheter use, and mechanical ventilation as well as and acquisition of CLABSI, VAE, or CAUTI. To reduce mortality risk, we shall focus on strategies to reduce LOS; strategies to reduce central-line, urinary catheter, and mechanical ventilation use; and HAI prevention recommendations.