Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries

Rosenthal V.D.; Jin Z.; Valderrama-Beltran S.L.; Gualtero S.M.; Linares C.Y.; Aguirre-Avalos G.; Mijangos-Méndez J.C.; Ibarra-Estrada M.Á.; Jiménez-Alvarez L.F.; Reyes L.P.; Alvarez-Moreno C.A.; Zuniga-Chavarria M.A.; Quesada-Mora A.M.; Gomez K.; Alarcon J.; Millan-Oñate J.; Aguilar-de-Moros D.; Castaño-Guerrero E.; Córdoba J.; Sassoe-Gonzalez A.; Millán-Castillo C.M.; Leyva-Xotlanihua L.; Aguilar-Moreno L.A.; Bravo-Ojeda J.S.; Gutierrez-Tobar I.F.; Aleman-Bocanegra M.C.; Echazarreta-Martínez C.V.; Flores-Sánchez B.M.; Cano-Medina Y.A.; Chapeta-Parada E.G.; Gonzalez-Niño R.A.; Villegas-Mota M.I.; Montoya-Malváez M.; Cortés-Vázquez M.Á.; Medeiros E.A.; Fram D.; Vieira-Escudero D.; Dueñas L.; Carreazo N.Y.; Salgado E.; Yin R. · American Journal of Infection Control (2023) · DOI: 10.1016/j.ajic.2023.03.006

Resumen

Background: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. Methods: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). Results: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. Conclusions: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.

Instituciones: Universidad Peruana de Ciencias Aplicadas