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
Authors: Rosenthal Victor Daniel , Yin Ruijie , Valderrama-Beltran Sandra Liliana , Gualtero Sandra Milena , Linares Claudia Yaneth , Aguirre-Avalos Guadalupe , Mijangos-Méndez Julio Cesar , Ibarra-Estrada Miguel Ángel , Jimenez-Alvarez Luisa Fernanda , Reyes Lidia Patricia , Alvarez-Moreno Carlos Arturo , Zuniga-Chavarria Maria Adelia , Quesada-Mora Ana Marcela , Gomez Katherine , Alarcon Johana , Oñate Jose Millan , Aguilar-De-Moros Daisy , Castaño-Guerra Elizabeth , Córdoba Judith , Sassoe-Gonzalez Alejandro , Millán-Castillo Claudia Marisol , Xotlanihua Lissette Leyva , Aguilar-Moreno Lina Alejandra , Ojeda Juan Sebastian Bravo , Tobar Ivan Felipe Gutierrez , Aleman-Bocanegra Mary Cruz , Echazarreta-Martínez Clara Veronica , Flores-Sánchez Belinda Mireya , Cano-Medina Yuliana Andrea , Chapeta-Parada Edwin Giovannny , Gonzalez-Niño Rafael Antonio , Villegas-Mota Maria Isabel , Montoya-Malváez Mildred , Cortés-Vázquez Miguel Ángel , Medeiros Eduardo Alexandrino , Fram Dayana , Vieira-Escudero Daniela , Jin Zhilin 
Published: October 2022

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.