Hostname: page-component-745bb68f8f-d8cs5 Total loading time: 0 Render date: 2025-01-22T11:00:02.612Z Has data issue: false hasContentIssue false
  • English
  • Français

Multinational prospective study of incidence and risk factors for central-line–associated bloodstream infections in 728 intensive care units of 41 Asian, African, Eastern European, Latin American, and Middle Eastern countries over 24 years

Published online by Cambridge University Press:  28 April 2023

Victor Daniel Rosenthal Open the ORCID record for Victor Daniel Rosenthal [Opens in a new window] ,
Ruijie Yin Open the ORCID record for Ruijie Yin [Opens in a new window] ,
Sheila Nainan Myatra Open the ORCID record for Sheila Nainan Myatra [Opens in a new window] ,
Ziad A. Memish Open the ORCID record for Ziad A. Memish [Opens in a new window] ,
Camilla Rodrigues ,
Mohit Kharbanda ,
Sandra Liliana Valderrama-Beltran ,
Yatin Mehta Open the ORCID record for Yatin Mehta [Opens in a new window] ,
Majeda Afeef Al-Ruzzieh  and
Guadalupe Aguirre-Avalos Open the ORCID record for Guadalupe Aguirre-Avalos [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, Florida, United States INICC Foundation, International Nosocomial Infection Control Consortium, Miami, Florida, United States
Ruijie Yin
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
Sheila Nainan Myatra
Affiliation:
Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
Ziad A. Memish
Affiliation:
King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
Camilla Rodrigues
Affiliation:
Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
Mohit Kharbanda
Affiliation:
Desun Hospital, Kolkata, India
Sandra Liliana Valderrama-Beltran
Affiliation:
Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
Yatin Mehta
Affiliation:
Medanta The Medicity, Haryana, India
Majeda Afeef Al-Ruzzieh
Affiliation:
King Hussein Cancer Center, Amman, Jordan
Guadalupe Aguirre-Avalos
Affiliation:
Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
Ertugrul Guclu
Affiliation:
Sakarya University Training and Research Hospital, Sakarya, Turkey
Chin Seng Gan
Affiliation:
University Malaya Medical Centre, Kuala Lumpur, Malaysia
Luisa Fernanda Jiménez Alvarez
Affiliation:
Clinica Universitaria Colombia, Bogota, Colombia
Rajesh Chawla
Affiliation:
Indraprastha Apollo Hospitals, New Delhi, India
Sona Hlinkova
Affiliation:
Faculty of Health, Catholic University in Ruzomberok, Ruzomberok, Slovakia Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
Rajalakshmi Arjun
Affiliation:
Kerala Institute of Med Sciences Health, Trivandrum, India
Hala Mounir Agha
Affiliation:
Cairo University Specialized Pediatric Hospital, Cairo, Egypt
Maria Adelia Zuniga Chavarria
Affiliation:
Hospital Clinica Biblica, San Jose de Costa Rica, Costa Rica
Narangarav Davaadagva
Affiliation:
Intermed Hospital, Ulaanbaatar, Ulaanbaatar, Mongolia
Yin Hoong Lai
Affiliation:
International Islamic University Malaysia, Kuantan Pahang, Malaysia
Katherine Gomez
Affiliation:
Clinica Sebastian de Belalcazar, Cali, Colombia
Daisy Aguilar-de-Moros
Affiliation:
Hospital del Niño Dr José Renán Esquivel, Panama City, Panama
Chian-Wern Tai
Affiliation:
Universiti Kebangsaan Malaysia Specialist Children’s Hospital, Kuala Lumpur, Malaysia
Alejandro Sassoe Gonzalez
Affiliation:
Hospital Regional de Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico
Lina Alejandra Aguilar Moreno
Affiliation:
Clinica Infantil Santa María del Lago, Bogota, Colombia
Kavita Sandhu
Affiliation:
Max Super Speciality Hospital Saket Delhi, New Delhi, India
Jarosław Janc
Affiliation:
Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
Mary Cruz Aleman Bocanegra
Affiliation:
Hospital San Jose TecSalud, Monterrey, Nuevo León, México
Dincer Yildizdas
Affiliation:
Cukurova University. Balcali Hospital, Adana, Turkey
Yuliana Andrea Cano Medina
Affiliation:
Instituto Del Corazon De Bucaramanga Sede Bogota, Bogota, Colombia
Maria Isabel Villegas Mota
Affiliation:
Instituto Nacional de Perinatología, México DF, México
Abeer Aly Omar
Affiliation:
Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
Wieslawa Duszynska
Affiliation:
Wroclaw Medical University. Department of Anesthesiology and Intensive Therapy, Wroclaw, Poland
Amani Ali El-Kholy
Affiliation:
Dar Alfouad Hospital, 6th of October City, Egypt
Safaa Abdulaziz Alkhawaja
Affiliation:
Salmaniya Medical Center, Manama, Bahrain
George Horhat Florin
Affiliation:
University of Medicine and Pharmacy Victor Babes, Timisoara, Romania Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
Eduardo Alexandrino Medeiros
Affiliation:
Hospital Sao Paulo, Universidade Federal de Sao Paulo, Sao Paulo, Brazil
Lili Tao
Affiliation:
Zhongshan Hospital, Fudan University, Shanghai, China
Nellie Tumu
Affiliation:
Port Moresby General Hospital, Port Moresby, Papua, New Guinea
May Gamar Elanbya
Affiliation:
National Infection control Program, Khartoum, Sudan
Reshma Dongol
Affiliation:
Grande International Hospital, Kathmandu, Nepal
Vesna Mioljević
Affiliation:
Clinical Center of Serbia, Belgrade, Serbia
Lul Raka
Affiliation:
National Institute For Public Health, Prishtina, Kosovo
Lourdes Dueñas
Affiliation:
Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Nilton Yhuri Carreazo
Affiliation:
Universidad Peruana de Ciencias Aplicadas, Lima, Peru Hospital de Emergencias Pediatricas, Lima, Peru
Tarek Dendane
Affiliation:
Hôpital Ibn Sina, Rabat, Morocco
Aamer Ikram
Affiliation:
National Institutes of Health, Islamabad, Pakistan
Tala Kardas
Affiliation:
American University of Beirut Medical Center, Beirut, Lebanon
Michael M. Petrov
Affiliation:
Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
Asma Bouziri
Affiliation:
Hôpital d’enfants, Tunis, Tunisia
Nguyen Viet-Hung
Affiliation:
Bach Mai Hospital, Hanoi, Vietnam
Vladislav Belskiy
Affiliation:
Privolzhskiy District Medical Center, Nizhniy Novgorod, Russia
Naheed Elahi
Affiliation:
Dubai Hospital, Dubai, United Arab Emirates
Estuardo Salgado
Affiliation:
Hospital de Especialidades, Alianza Del Ecuador, Ecuador
Zhilin Jin
Affiliation:
Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
*
Corresponding author: Victor D. Rosenthal, MD, Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th Street, Floor 9, Office 912, Miami, FL 33136, USA. E-mail: [email protected], [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To identify central-line (CL)–associated bloodstream infection (CLABSI) incidence and risk factors in low- and middle-income countries (LMICs).

Design:

From July 1, 1998, to February 12, 2022, we conducted a multinational multicenter prospective cohort study using online standardized surveillance system and unified forms.

Setting:

The study included 728 ICUs of 286 hospitals in 147 cities in 41 African, Asian, Eastern European, Latin American, and Middle Eastern countries.

Patients:

In total, 278,241 patients followed during 1,815,043 patient days acquired 3,537 CLABSIs.

Methods:

For the CLABSI rate, we used CL days as the denominator and the number of CLABSIs as the numerator. Using multiple logistic regression, outcomes are shown as adjusted odds ratios (aORs).

Results:

The pooled CLABSI rate was 4.82 CLABSIs per 1,000 CL days, which is significantly higher than that reported by the Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed 11 variables, and the following variables were independently and significantly associated with CLABSI: length of stay (LOS), risk increasing 3% daily (aOR, 1.03; 95% CI, 1.03–1.04; P < .0001), number of CL days, risk increasing 4% per CL day (aOR, 1.04; 95% CI, 1.03–1.04; P < .0001), surgical hospitalization (aOR, 1.12; 95% CI, 1.03–1.21; P < .0001), tracheostomy use (aOR, 1.52; 95% CI, 1.23–1.88; P < .0001), hospitalization at a publicly owned facility (aOR, 3.04; 95% CI, 2.31–4.01; P <.0001) or at a teaching hospital (aOR, 2.91; 95% CI, 2.22–3.83; P < .0001), hospitalization in a middle-income country (aOR, 2.41; 95% CI, 2.09–2.77; P < .0001). The ICU type with highest risk was adult oncology (aOR, 4.35; 95% CI, 3.11–6.09; P < .0001), followed by pediatric oncology (aOR, 2.51;95% CI, 1.57–3.99; P < .0001), and pediatric (aOR, 2.34; 95% CI, 1.81–3.01; P < .0001). The CL type with the highest risk was internal-jugular (aOR, 3.01; 95% CI, 2.71–3.33; P < .0001), followed by femoral (aOR, 2.29; 95% CI, 1.96–2.68; P < .0001). Peripherally inserted central catheter (PICC) was the CL with the lowest CLABSI risk (aOR, 1.48; 95% CI, 1.02–2.18; P = .04).

Conclusions:

The following CLABSI risk factors are unlikely to change: country income level, facility ownership, hospitalization type, and ICU type. These findings suggest a focus on reducing LOS, CL days, and tracheostomy; using PICC instead of internal-jugular or femoral CL; and implementing evidence-based CLABSI prevention recommendations.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 11 , November 2023 , pp. 1737 - 1747
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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;145:582–591.10.7326/0003-4819-145-8-200610170-00007CrossRefGoogle 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
Rosenthal, VD. Central-line–associated bloodstream infections in limited-resource countries: a review of the literature. Clin Infect Dis 2009;49:1899–1907.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Myatra, SN, Divatia, JV, et al. The impact of COVID-19 on healthcare-associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings. Int J Infect Dis 2022.10.1016/j.ijid.2022.02.041CrossRefGoogle ScholarPubMed
Rosenthal, VD, Yin, R, Lu, Y, et al. The impact of healthcare-associated infections on mortality in ICU: a prospective study in Asia, Africa, Eastern Europe, Latin America, and the Middle East. Am J Infect Control 2022.Google ScholarPubMed
Rosenthal, VD, Jin, Z, Rodrigues, C, et al. Risk factors for mortality over 18 years in 317 ICUs in 9 Asian countries: the impact of healthcare-associated infections. Infect Control Hosp Epidemiol 2022. doi: 10.1017/ice.2022.245.Google ScholarPubMed
Rosenthal, VD, Jin, Z, Memish, ZA, et al. Risk factors for mortality in ICU patients in 10 Middle Eastern countries: The role of healthcare-associated infections. J Crit Care 2022;72:154149.CrossRefGoogle ScholarPubMed
Centers for Disease C, Prevention. Vital signs: central-line–associated bloodstream infections—United States, 2001, 2008, and 2009. Morb Mortal Wkly Rep 2011;60:243–248.Google Scholar
Stone, PW, Braccia, D, Larson, E. Systematic review of economic analyses of healthcare-associated infections. Am J Infect Control 2005;33:501–509.10.1016/j.ajic.2005.04.246CrossRefGoogle Scholar
Rosenthal, VD, Guzman, S, Migone, O, Crnich, CJ. The attributable cost, length of hospital stay, and mortality of central-line–associated bloodstream infection in intensive care departments in Argentina: a prospective, matched analysis. Am J Infect Control 2003;31:475–480.CrossRefGoogle ScholarPubMed
Higuera, F, Rangel-Frausto, MS, Rosenthal, VD, et al. Attributable cost and length of stay for patients with central venous catheter–associated bloodstream infection in Mexico City intensive care units: a prospective, matched analysis. Infect Control Hosp Epidemiol 2007;28:31–35.10.1086/510812CrossRefGoogle ScholarPubMed
Tarricone, R, Torbica, A, Franzetti, F, Rosenthal, VD. Hospital costs of central-line–associated bloodstream infections and cost-effectiveness of closed vs open infusion containers. The case of intensive care units in Italy. Cost Eff Resour Alloc 2010;8:8.10.1186/1478-7547-8-8CrossRefGoogle 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;43:553–569.CrossRefGoogle Scholar
Almuneef, MA, Memish, ZA, Balkhy, HH, Hijazi, O, Cunningham, G, Rate, Francis C., risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006;62:207–213.CrossRefGoogle Scholar
Lorente, L, Henry, C, Martin, MM, Jimenez, A, Mora, ML. Central venous catheter–related infection in a prospective and observational study of 2,595 catheters. Crit Care 2005;9:R631–R635.CrossRefGoogle Scholar
O’Horo, JC, Maki, DG, Krupp, AE, Safdar, N. Arterial catheters as a source of bloodstream infection: a systematic review and meta-analysis. Crit Care Med 2014;42:1334–1339.CrossRefGoogle ScholarPubMed
Alonso-Echanove, J, Edwards, JR, Richards, MJ, et al. Effect of nurse staffing and antimicrobial-impregnated central venous catheters on the risk for bloodstream infections in intensive care units. Infect Control Hosp Epidemiol 2003;24:916–925.CrossRefGoogle ScholarPubMed
Dudeck, MA, Edwards, JR, Allen-Bridson, K, et al. National Healthcare Safety Network report, data summary for 2013, device-associated module. Am J Infect Control 2015;43:206–221.CrossRefGoogle Scholar
Rosenthal, VD. International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control 2016;44:e81–e90.10.1016/j.ajic.2016.01.005CrossRefGoogle ScholarPubMed
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
New World Bank country classifications by income level: 2021–2022. World Bank website. https://blogs.worldbank.org/opendata/new-world-bank-country-classifications-income-level-2021-20222022. Published 2022. Accessed April 14, 2023.Google Scholar
Glossary of terms. WHO European Primary Health Care Impact Performance and Capacity Tool (PHC-IMPACT). World Health Organization website. https://apps.who.int/iris/handle/10665/346481. Accessed April 14, 2023.Google Scholar
Higuera, F, Rosenthal, VD, Duarte, P, Ruiz, J, Franco, G, Safdar, N. The effect of process control on the incidence of central venous catheter-associated bloodstream infections and mortality in intensive care units in Mexico. Crit Care Med 2005;33:2022–2027.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Maki, DG, Rodrigues, C, et al. Impact of International Nosocomial Infection Control Consortium (INICC) strategy on central-line–associated bloodstream infection rates in the intensive care units of 15 developing countries. Infect Control Hosp Epidemiol 2010;31:1264–1272.10.1086/657140CrossRefGoogle ScholarPubMed
Rosenthal, VD, Ramachandran, B, Villamil-Gomez, W, et al. Impact of a multidimensional infection control strategy on central-line–associated bloodstream infection rates in pediatric intensive care units of five developing countries: findings of the International Nosocomial Infection Control Consortium (INICC). Infection 2012;40:415–423.CrossRefGoogle ScholarPubMed
Jaggi, N, Rodrigues, C, Rosenthal, VD, et al. Impact of an International Nosocomial Infection Control Consortium multidimensional approach on central-line–associated bloodstream infection rates in adult intensive care units in eight cities in India. Int J Infect Dis 2013;17:e1218–e1224.10.1016/j.ijid.2013.07.007CrossRefGoogle ScholarPubMed
Leblebicioglu, H, Ozturk, R, Rosenthal, VD, et al. Impact of a multidimensional infection control approach on central-line–associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 2013;12:10.CrossRefGoogle Scholar
Rosenthal, VD, Duenas, L, Sobreyra-Oropeza, M, et al. Findings of the International Nosocomial Infection Control Consortium (INICC), part III: effectiveness of a multidimensional infection control approach to reduce central-line–associated bloodstream infections in the neonatal intensive care units of 4 developing countries. Infect Control Hosp Epidemiol 2013;34:229–237.10.1086/669511CrossRefGoogle ScholarPubMed
Alvarez-Moreno, CA, Valderrama-Beltran, SL, Rosenthal, VD, et al. Multicenter study in Colombia: impact of a multidimensional International Nosocomial Infection Control Consortium (INICC) approach on central-line–associated bloodstream infection rates. Am J Infect Control 2016;44:e235–e241.CrossRefGoogle Scholar
Jeon, CY, Neidell, M, Jia, H, Sinisi, M, Larson, E. On the role of length of stay in healthcare-associated bloodstream infection. Infect Control Hosp Epidemiol 2012;33:1213–1218.CrossRefGoogle Scholar
Rey, C, Alvarez, F, De-La-Rua, V, et al. Intervention to reduce catheter-related bloodstream infections in a pediatric intensive care unit. Intensive Care Med 2011;37:678–685.10.1007/s00134-010-2116-xCrossRefGoogle Scholar
Lorente, L, Jimenez, A, Naranjo, C, et al. Higher incidence of catheter-related bacteremia in jugular site with tracheostomy than in femoral site. Infect Control Hosp Epidemiol 2010;31:311–313.10.1086/651065CrossRefGoogle ScholarPubMed
Chopra, V, O’Horo, JC, Rogers, MA, Maki, DG, Safdar, N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol 2013;34:908–918.CrossRefGoogle ScholarPubMed
Hon, K, Bihari, S, Holt, A, Bersten, A, Kulkarni, H. Rate of catheter-related bloodstream infections between tunneled central venous catheters versus peripherally inserted central catheters in adult home parenteral nutrition: a meta-analysis. J Parenter Enteral Nutr 2019;43:41–53.CrossRefGoogle Scholar
Rosenthal, VD, Lynch, P, Jarvis, WR, et al. Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC. Infection 2011;39:439–450.CrossRefGoogle ScholarPubMed
Rosenthal, VD, Jarvis, WR, Jamulitrat, S, et al. Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: international Nosocomial Infection Control Consortium findings. Pediatr Crit Care Med 2012;13:399–406.CrossRefGoogle Scholar
Dahan, M, O’Donnell, S, Hebert, J, et al. CLABSI RISK FActors in the NICU: potential for prevention: a PICNIC study. Infect Control Hosp Epidemiol 2016;37:1446–1452.CrossRefGoogle Scholar
Hsu, JF, Chang, HL, Tsai, MJ, et al. Port type is a possible risk factor for implantable venous access port–related bloodstream infections and no sign of local infection predicts the growth of gram-negative bacilli. World J Surg Oncol 2015;13:288.10.1186/s12957-015-0707-2CrossRefGoogle ScholarPubMed