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Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: The impact of healthcare-associated infections

Published online by Cambridge University Press:  24 October 2022

Victor Daniel Rosenthal Open the ORCID record for Victor Daniel Rosenthal [Opens in a new window] ,
Zhilin Jin ,
Camilla Rodrigues ,
Sheila Nainan Myatra Open the ORCID record for Sheila Nainan Myatra [Opens in a new window] ,
Jigeeshu Vasishth Divatia Open the ORCID record for Jigeeshu Vasishth Divatia [Opens in a new window] ,
Sanjay K. Biswas Open the ORCID record for Sanjay K. Biswas [Opens in a new window] ,
Anjana Mahesh Shrivastava Open the ORCID record for Anjana Mahesh Shrivastava [Opens in a new window] ,
Mohit Kharbanda Open the ORCID record for Mohit Kharbanda [Opens in a new window] ,
Bikas Nag  and
Yatin Mehta Open the ORCID record for Yatin Mehta [Opens in a new window]
...Show all authors
Victor Daniel Rosenthal*
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, United States
Zhilin Jin
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
Camilla Rodrigues
Affiliation:
Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
Sheila Nainan Myatra
Affiliation:
Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
Jigeeshu Vasishth Divatia
Affiliation:
Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
Sanjay K. Biswas
Affiliation:
Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
Anjana Mahesh Shrivastava
Affiliation:
Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
Mohit Kharbanda
Affiliation:
Desun Hospital, Kolkata, India
Bikas Nag
Affiliation:
Desun Hospital, Kolkata, India
Yatin Mehta
Affiliation:
Medanta the Medicity, Haryana, India
Smita Sarma
Affiliation:
Medanta the Medicity, Haryana, India
Subhash Kumar Todi
Affiliation:
Advanced Medicare Research Institute (AMRI) Hospitals, Kolkata, India
Mahuya Bhattacharyya
Affiliation:
Advanced Medicare Research Institute (AMRI) Hospitals, Kolkata, India
Arpita Bhakta
Affiliation:
Advanced Medicare Research Institute (AMRI) Hospitals, Kolkata, India
Chin Seng Gan
Affiliation:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Michelle Siu Yee Low
Affiliation:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Marissa Bt Madzlan Kushairi
Affiliation:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Soo Lin Chuah
Affiliation:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Qi Yuee Wang
Affiliation:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Rajesh Chawla
Affiliation:
Indraprastha Apollo Hospitals, New Delhi, India
Aakanksha Chawla Jain
Affiliation:
Indraprastha Apollo Hospitals, New Delhi, India
Sudha Kansal
Affiliation:
Indraprastha Apollo Hospitals, New Delhi, India
Roseleen Kaur Bali
Affiliation:
Indraprastha Apollo Hospitals, New Delhi, India
Rajalakshmi Arjun
Affiliation:
Kerala Institute of Medical Sciences, Trivandrum, India
Narangarav Davaadagva
Affiliation:
Kerala Institute of Medical Sciences, Trivandrum, India
Batsuren Bat-Erdene
Affiliation:
Kerala Institute of Medical Sciences, Trivandrum, India
Tsolmon Begzjav
Affiliation:
Kerala Institute of Medical Sciences, Trivandrum, India
Mat Nor Mohd Basri
Affiliation:
International Islamic University Malaysia, Kuantan Pahang, Malaysia
Chian-Wern Tai
Affiliation:
Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Pei-Chuen Lee
Affiliation:
Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Swee-Fong Tang
Affiliation:
Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Kavita Sandhu
Affiliation:
Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
Binesh Badyal
Affiliation:
Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
Ankush Arora
Affiliation:
Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
Deep Sengupta
Affiliation:
Max Super Speciality Hospital, Saket, Delhi, New Delhi, India
Ruijie Yin
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, United States
*
Author for correspondence: Victor Daniel Rosenthal, E-mail: victor_rosenthal@inicc.org
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Abstract

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.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 8 , August 2023 , pp. 1261 - 1266
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Callahan, D. Managed care and the goals of medicine. J Am Geriatr Soc 1998;46:385–388.CrossRefGoogle ScholarPubMed
Rosenthal, VD. International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control 2016;44:e81–e90.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Maki, DG, Graves, N. The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. Am J Infect Control 2008;36:e1–e12.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Maki, DG, Salomao, R, et al. Device-associated nosocomial infections in 55 intensive care units of 8 developing countries. Ann Intern Med 2006;145:582–591.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Maki, DG, Mehta, A, et al. International Nosocomial Infection Control Consortium report, data summary for 2002–2007, issued January 2008. Am J Infect Control 2008;36:627–637.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Maki, DG, Jamulitrat, S, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003–2008, issued June 2009. Am J Infect Control 2010;38:95–104.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Bijie, H, Maki, DG, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 36 countries, for 2004–2009. Am J Infect Control 2012;40:396–407.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Maki, DG, Mehta, Y, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007–2012: device-associated module. Am J Infect Control 2014;42:942–956.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Al-Abdely, HM, El-Kholy, AA, et al. International Nosocomial Infection Control Consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control 2016;44:1495–1504.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Bat-Erdene, I, Gupta, D, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012–2017: device-associated module. Am J Infect Control 2020;48:423–432.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Duszynska, W, Ider, BE, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2013–2018, adult and pediatric units, device-associated module. Am J Infect Control 2021;49:1267–1274.CrossRefGoogle ScholarPubMed
Ylipalosaari, P, Ala-Kokko, TI, Laurila, J, Ohtonen, P, Syrjala, H. Intensive care–acquired infection is an independent risk factor for hospital mortality: a prospective cohort study. Crit Care 2006;10:R66.CrossRefGoogle ScholarPubMed
Zhu, S, Wang, W, Kang, Y, et al. Clinical outcomes and risk factors for mortality from ventilator-associated events: a registry-based cohort study among 30,830 intensive care unit patients. Infect Control Hosp Epidemiol 2022;43:48–55.CrossRefGoogle Scholar
Mukhopadhyay, A, Tai, BC, See, KC, et al. Risk factors for hospital and long-term mortality of critically ill elderly patients admitted to an intensive care unit. Biomed Res Int 2014;2014:960575.CrossRefGoogle Scholar
Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.CrossRefGoogle ScholarPubMed
Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of healthcare-associated infection and criteria for specific types of infections in the acute-care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
Toufen, C Jr, Franca, SA, Okamoto, VN, Salge, JM, Carvalho, CR. Infection as an independent risk factor for mortality in the surgical intensive care unit. Clinics (Sao Paulo) 2013;68:1103–1108.Google ScholarPubMed
Chittawatanarat, K, Jaipakdee, W, Chotirosniramit, N, Chandacham, K, Microbiology, Jirapongcharoenlap T., resistance patterns, and risk factors of mortality in ventilator-associated bacterial pneumonia in a northern Thai tertiary-care university based general surgical intensive care unit. Infect Drug Resist 2014;7:203–210.CrossRefGoogle Scholar
Garg, R, Tellapragada, C, Shaw, T, et al. Epidemiology of sepsis and risk factors for mortality in intensive care unit: a hospital based prospective study in South India. Infect Dis (Lond) 2022;54:325–334.CrossRefGoogle ScholarPubMed
But, A, Yetkin, MA, Kanyilmaz, D, et al. Analysis of epidemiology and risk factors for mortality in ventilator-associated pneumonia attacks in intensive care unit patients. Turk J Med Sci 2017;47:812–816.CrossRefGoogle ScholarPubMed
Cheewinmethasiri, J, Chittawatanarat, K, Chandacham, K, Jirapongchareonlap, T, Chotirosniramit, N. Microbiology, risk factors, and mortality of patients with intravenous catheter-related bloodstream infections in the surgical intensive care unit: a five-year, concurrent, case-controlled study. J Med Assoc Thai 2014;97 suppl 1:S93–S101.Google Scholar
Eggleston, K, Shen, YC, Lau, J, Schmid, CH, Chan, J. Hospital ownership and quality of care: what explains the different results in the literature? Health Econ 2008;17:1345–1362.CrossRefGoogle ScholarPubMed
Devereaux, PJ, Choi, PT, Lacchetti, C, et al. A systematic review and meta-analysis of studies comparing mortality rates of private for-profit and private not-for-profit hospitals. CMAJ 2002;166:1399–1406.Google ScholarPubMed
Klompas, M, Branson, R, Cawcutt, K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2022;43:687–713.CrossRefGoogle ScholarPubMed
Buetti, N, Marschall, J, Drees, M, et al. Strategies to prevent central-line–associated bloodstream infections in acute-care hospitals: 2022 update. Infect Control Hosp Epidemiol 2022;43(5):1–17. doi: 10.1017/ice.2022.87.CrossRefGoogle ScholarPubMed