Risk factors for mortality in ICU patients in 10 middle eastern countries: The role of healthcare-associated infections.

Humans Female Catheter-Related Infections Prospective Studies Cross Infection / prevention & control Intensive Care Units Pneumonia, Ventilator-Associated Risk Factors Delivery of Health Care

Critical care Health-care associated infections Intensive care unit Middle East Mortality Nosocomial infection Risk factor

Journal

Journal of critical care

ISSN: 1557-8615

Titre abrégé: J Crit Care

Pays: United States

ID NLM: 8610642

Informations de publication

Date de publication:
12 2022

Historique:

received: 18 07 2022

revised: 03 09 2022

accepted: 03 09 2022

pubmed: 16 9 2022

medline: 30 11 2022

entrez: 15 9 2022

Statut: ppublish

Résumé

The International Nosocomial Infection Control Consortium (INICC) found a high mortality rate in ICUs of the Middle East (ME). Our goal was to identify mortality risk factor (RF) in ICUs of the ME. From 08/01/2003 to 02/12/2022, we conducted a prospective cohort study in 236 ICUs of 77 hospitals in 44 cities in 10 countries of ME. We analyzed 16 independent variables using multiple logistic regression. 66,440 patients, hospitalized during 652,167 patient-days, and 13,974 died. We identified following mortality RF: Age (adjusted odds ratio (aOR):1.02;p < 0.0001) rising risk 2% yearly; length of stay (LOS) (aOR:1.02;p < 0.0001) rising the risk 2% per day; central line (CL)-days (aOR:1.01;p < 0.0001) rising risk 1% per day; mechanicalventilator (MV) utilization-ratio (aOR:14.51;p < 0.0001); CL-associated bloodstream infection (CLABSI) acquisition (aOR):1.49;p < 0.0001); ventilator-associated pneumonia (VAP) acquisition (aOR:1.50;p < 0.0001); female gender (OR:1.14;p < 0.0001); hospitalization at a public-hospital (OR:1.31;p < 0.0001); and medical-hospitalization (aOR:1.64;p < 0.0001). High-income countries showed lowest risk (aOR:0.59;p < 0.0001). Some identified RF are unlikely to change, such as country income-level, facility ownership, hospitalization type, gender, and age. Some can be modified; LOS, CL-use, MV-use, CLABSI, VAP. So, to lower the mortality risk in ICUs, we recommend focusing on strategies to shorten the LOS, reduce CL and MV-utilization, and use evidence-based recommendations to prevent CLABSI and VAP.

Identifiants

DOI: 10.1016/j.jcrc.2022.154149 PMID: 36108349

pubmed: 36108349

pii: S0883-9441(22)00178-2

doi: 10.1016/j.jcrc.2022.154149

pii:

doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

Pagination

154149

Informations de copyright

Déclaration de conflit d'intérêts

Declaration of Competing Interest All authors report no conflicts of interest related to this article. The Institutional Review Board of each hospital agreed to the study protocol, and patient confidentiality was protected by codifying the recorded information, making it only identifiable to the infection control team.