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Rosenthal VD, Yin R, Rodrigues C, Myatra SN, Divatia JV, Biswas SK, Shrivastava AM, Kharbanda M, Nag B, Mehta Y, Sarma S, Todi SK, Bhattacharyya M, Bhakta A, Gan CS, Low MSY, Bt Madzlan Kushairi M, Chuah SL, Wang QY, Chawla R, Jain AC, Kansal S, Bali RK, Arjun R, Davaadagva N, Bat-Erdene I, Begzjav T, Mohd Basri MN, Tai CW, Lee PC, Tang SF, Sandhu K, Badyal B, Arora A, Sengupta D, Tao L, Jin Z. Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections over 18 years in 281 ICUs of 9 Asian countries. J Vasc Access 2024; 25:1508-1518. [PMID: 37151085 DOI: 10.1177/11297298231169542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors (RF) in Asia. METHODS From 03/27/2004 to 02/11/2022, we conducted a multinational multicenter prospective cohort study in 281 ICUs of 95 hospitals in 44 cities in 9 Asian countries (China, India, Malaysia, Mongolia, Nepal, Pakistan, Philippines, Sri Lanka, Thailand, and Vietnam). For estimation of CLABSI rate we used CL-days as denominator and number of CLABSI as numerator. To estimate CLABSI RF for we analyzed the data using multiple logistic regression, and outcomes are shown as adjusted odds ratios (aOR). RESULTS A total of 150,142 patients, hospitalized 853,604 days, acquired 1514 CLABSIs. Pooled CLABSI rate per 1000 CL-days was 5.08; per type of catheter were: femoral: 6.23; temporary hemodialysis: 4.08; jugular: 4.01; arterial: 3.14; PICC: 2.47; subclavian: 2.02. The highest rates were femoral, temporary for hemodialysis, and jugular, and the lowest PICC and subclavian. We analyzed following variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization ratio, CL-type, tracheostomy use, hospitalization type, ICU type, facility ownership and World Bank classifications by income level. Following were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 4% daily (aOR = 1.04; 95% CI = 1.03-1.04; p < 0.0001); number of CL-days before CLABSI acquisition, rising risk 5% per CL-day (aOR = 1.05; 95% CI 1.05-1.06; p < 0.0001); medical hospitalization (aOR = 1.21; 95% CI 1.04-1.39; p = 0.01); tracheostomy use (aOR = 2.02;95% CI 1.43-2.86; p < 0.0001); publicly-owned facility (aOR = 3.63; 95% CI 2.54-5.18; p < 0.0001); lower-middle-income country (aOR = 1.87; 95% CI 1.41-2.47; p < 0.0001). ICU with highest risk was pediatric (aOR = 2.86; 95% CI 1.71-4.82; p < 0.0001), followed by medical-surgical (aOR = 2.46; 95% CI 1.62-3.75; p < 0.0001). CL with the highest risk were internal-jugular (aOR = 3.32; 95% CI 2.84-3.88; p < 0.0001), and femoral (aOR = 3.13; 95% CI 2.48-3.95; p < 0.0001), and subclavian (aOR = 1.78; 95% CI 1.47-2.15; p < 0.0001) showed the lowest risk. CONCLUSIONS The following CLABSI RFs are unlikely to change: country income level, facility-ownership, hospitalization type, and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, and tracheostomy; using subclavian or PICC instead of internal-jugular or femoral; and implementing evidence-based CLABSI prevention recommendations.
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Affiliation(s)
- Victor Daniel Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- International Nosocomial Infection Control Consortium (INICC) Foundation, Miami, FL, USA
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Camilla Rodrigues
- Department of Microbiology, Pd Hinduja National Hospital and Medical Research Centre, Mumbai, India
| | - Sheila Nainan Myatra
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
| | - Jigeeshu Vasishth Divatia
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
| | - Sanjay K Biswas
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
| | - Anjana Mahesh Shrivastava
- Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha Nacional Institute, Mumbai, India
| | | | - Bikas Nag
- Department of Critical Care, Desun Hospital, Kolkata, India
| | - Yatin Mehta
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Haryana, India
| | - Smita Sarma
- Department of Critical Care and Anesthesiology, Medanta The Medicity, Haryana, India
| | - Subhash Kumar Todi
- Department of Critical Care, Advanced Medicare Research Institute AMRI Hospitals, Kolkata, India
| | - Mahuya Bhattacharyya
- Department of Critical Care, Advanced Medicare Research Institute AMRI Hospitals, Kolkata, India
| | - Arpita Bhakta
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Chin Seng Gan
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Michelle Siu Yee Low
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | - Soo Lin Chuah
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Qi Yuee Wang
- Department of Pediatric Intensive Care, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Rajesh Chawla
- Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
| | | | - Sudha Kansal
- Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
| | - Roseleen Kaur Bali
- Department of Critical Care, Indraprastha Apollo Hospitals, New Delhi, India
| | - Rajalakshmi Arjun
- Department of Critical Care, Kerala Institute of Medical Sciences Health, Trivandrum, India
| | | | | | | | - Mat Nor Mohd Basri
- Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | - Chian-Wern Tai
- Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | - Pei-Chuen Lee
- Department of Anesthesia and Critical Care, International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | - Swee-Fong Tang
- Department of Critical Care, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Kavita Sandhu
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Binesh Badyal
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Ankush Arora
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Deep Sengupta
- Department of Critical Care, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Lili Tao
- Department of Pneumonology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Rosenthal VD, Yin R, Nercelles P, Rivera-Molina SE, Jyoti S, Dongol R, Aguilar-De-Moros D, Tumu N, Alarcon-Rua J, Stagnaro JP, Alkhawaja S, Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha HM, Sahu S, Anusandhan SO, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Zand F, Abdellatif-Daboor M, Tai CW, Gan CS, Mat Nor MB, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Belskiy V, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Jin Z. International Nosocomial Infection Control Consortium (INICC) report of health care associated infections, data summary of 45 countries for 2015 to 2020, adult and pediatric units, device-associated module. Am J Infect Control 2024; 52:1002-1011. [PMID: 38185380 DOI: 10.1016/j.ajic.2023.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND Reporting on the International Nosocomial Infection Control Consortium study results from 2015 to 2020, conducted in 630 intensive care units across 123 cities in 45 countries spanning Africa, Asia, Eastern Europe, Latin America, and the Middle East. METHODS Prospective intensive care unit patient data collected via International Nosocomial Infection Control Consortium Surveillance Online System. Centers for Disease Control and Prevention/National Health Care Safety Network definitions applied for device-associated health care-associated infections (DA-HAI). RESULTS We gathered data from 204,770 patients, 1,480,620 patient days, 936,976 central line (CL)-days, 637,850 mechanical ventilators (MV)-days, and 1,005,589 urinary catheter (UC)-days. Our results showed 4,270 CL-associated bloodstream infections, 7,635 ventilator-associated pneumonia, and 3,005 UC-associated urinary tract infections. The combined rates of DA-HAIs were 7.28%, and 10.07 DA-HAIs per 1,000 patient days. CL-associated bloodstream infections occurred at 4.55 per 1,000 CL-days, ventilator-associated pneumonias at 11.96 per 1,000 MV-days, and UC-associated urinary tract infections at 2.91 per 1,000 UC days. In terms of resistance, Pseudomonas aeruginosa showed 50.73% resistance to imipenem, 44.99% to ceftazidime, 37.95% to ciprofloxacin, and 34.05% to amikacin. Meanwhile, Klebsiella spp had resistance rates of 48.29% to imipenem, 72.03% to ceftazidime, 61.78% to ciprofloxacin, and 40.32% to amikacin. Coagulase-negative Staphylococci and Staphylococcus aureus displayed oxacillin resistance in 81.33% and 53.83% of cases, respectively. CONCLUSIONS The high rates of DA-HAI and bacterial resistance emphasize the ongoing need for continued efforts to control them.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
| | | | - Sara E Rivera-Molina
- Department of Infection Prevention, Hospital Maria Especialidades Pediátricas, Tegucigalpa, Honduras
| | - Somani Jyoti
- Department of Infection Prevention, National University Hospital, Singapore, Singapore
| | - Reshma Dongol
- Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
| | - Daisy Aguilar-De-Moros
- Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
| | - Nellie Tumu
- Department of Infection Prevention, Port Moresby General Hospital, Port Moresby, Papua New Guinea
| | - Johana Alarcon-Rua
- Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
| | - Juan P Stagnaro
- Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
| | - Safaa Alkhawaja
- Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Yuliana A Cano-Medina
- Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
| | - Sandra L Valderrama-Beltran
- Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Claudia M Henao-Rodas
- Department of Infection Prevention, Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
| | - Maria A Zuniga-Chavarria
- Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
| | - Amani El-Kholy
- Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
| | - Hala Mounir Agha
- Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | - Suneeta Sahu
- Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | - Siksha O Anusandhan
- Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
| | - Mahuya Bhattacharyya
- Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
| | - Mohit Kharbanda
- Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
| | - Aruna Poojary
- Department of Microbiology, Breach Candy Hospital Trust, Mumbai, India
| | - Pravin K Nair
- Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | - Farid Zand
- Department of Infection Prevention, Nemazee Hospital Shiraz University Of Medical Sciences, Shiraz, Iran
| | | | - Chian-Wern Tai
- Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Chin S Gan
- Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mohd-Basri Mat Nor
- Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Blanca E Hernandez-Chena
- Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
| | - Isabel Villegas-Mota
- Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
| | - Mary C Aleman-Bocanegra
- Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ider Bat-Erdene
- Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nilton Y Carreazo
- Department of Infection Prevention, Hospital De Emergencias Pediatricas, Lima, Peru
| | | | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - Vladislav Belskiy
- Department of Infection Prevention, Privolzhskiy District Medical Center, Nizhniy Novgorod, Russia
| | - Sona Hlinkova
- Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Merve Havan
- Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
| | - Alper Koker
- Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
| | - Hulya Sungurtekin
- Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
| | - Ener C Dinleyici
- Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ertugrul Guclu
- Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Lili Tao
- Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, USA
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3
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Rosenthal VD, Jin Z, Brown EC, Dongol R, De Moros DA, Alarcon-Rua J, Perez V, Stagnaro JP, Alkhawaja S, Jimenez-Alvarez LF, Cano-Medina YA, Valderrama-Beltran SL, Henao-Rodas CM, Zuniga-Chavarria MA, El-Kholy A, Agha H, Sahu S, Mishra SB, Bhattacharyya M, Kharbanda M, Poojary A, Nair PK, Myatra SN, Chawla R, Sandhu K, Mehta Y, Rajhans P, Abdellatif-Daboor M, Chian-Wern T, Gan CS, Mohd-Basri MN, Aguirre-Avalos G, Hernandez-Chena BE, Sassoe-Gonzalez A, Villegas-Mota I, Aleman-Bocanegra MC, Bat-Erdene I, Carreazo NY, Castaneda-Sabogal A, Janc J, Hlinkova S, Yildizdas D, Havan M, Koker A, Sungurtekin H, Dinleyici EC, Guclu E, Tao L, Memish ZA, Yin R. Decreasing central line-associated bloodstream infections rates in intensive care units in 30 low- and middle-income countries: An INICC approach. Am J Infect Control 2024; 52:580-587. [PMID: 38154739 DOI: 10.1016/j.ajic.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. METHODS We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. RESULTS During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months. CONCLUSIONS The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.
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Affiliation(s)
- Victor D Rosenthal
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA; Department of Infection Prevention, INICC Foundation, International Nosocomial Infection Control Consortium, Miami, USA.
| | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eric C Brown
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Reshma Dongol
- Department of Infection Prevention, Grande International Hospital, Kathamandu, Nepal
| | - Daisy A De Moros
- Department of Infection Prevention, Hospital Del Nino Dr Jose Renan Esquivel De Panama, Panama, Panama
| | - Johana Alarcon-Rua
- Department of Infection Prevention, Clinica Sebastian De Belalcazar, Cali, Colombia
| | - Valentina Perez
- Department of Biological Sciences, Florida International University, Miami, Fl, USA
| | - Juan P Stagnaro
- Department of Infection Prevention, Instituto Central De Medicina, Provincia De Buenos Aires, La Plata, Argentina
| | - Safaa Alkhawaja
- Department of Infection Prevention, Salmaniya Medical Complex, Manama, Bahrain
| | | | - Yuliana A Cano-Medina
- Department of Infection Prevention, Instituto Del Corazon De Bucaramanga, Bogota, Colombia
| | - Sandra L Valderrama-Beltran
- Department of Infection Prevention, Pontificia Universidad Javeriana Hospital Universitario San Ignacio, Bogota, Colombia
| | - Claudia M Henao-Rodas
- Department of Infection Prevention, Fundacion Hospital San Jose De Buga, Guadalajara De Buga, Colombia
| | - Maria A Zuniga-Chavarria
- Department of Infection Prevention, Hospital Clinica Biblica, San Jose De Costa Rica, Costa Rica
| | - Amani El-Kholy
- Department of Infection Prevention, Dar Alfouad Hospital 6th Of October City, 6th Of October City, Egypt
| | - Hala Agha
- Department of Infection Prevention, Cairo University Specialized Pediatric Hospital Cardio Thoracic Icu, Cairo, Egypt
| | - Suneeta Sahu
- Department of Infection Prevention, Apollo Hospital Bhubaneswar, Bhubaneswar, India
| | - Shakti B Mishra
- Department of Infection Prevention, IMS And SUM Hospital, Bhubaneswar, India
| | - Mahuya Bhattacharyya
- Department of Infection Prevention, Advanced Medicare Research Institute Dhakuria Unit, Kolkata, India
| | - Mohit Kharbanda
- Department of Infection Prevention, Desun Hospital & Heart Institute Kolkata, Kolkata, India
| | - Aruna Poojary
- Department of Infection Prevention, Breach Candy Hospital Trust, Mumbai, India
| | - Pravin K Nair
- Department of Infection Prevention, Holy Spirit Hospital, Mumbai, India
| | - Sheila N Myatra
- Department of Critical Care, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajesh Chawla
- Department of Infection Prevention, Indraprastha Apollo Hospital Delhi, New Delhi, India
| | - Kavita Sandhu
- Department of Infection Prevention, Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Yatin Mehta
- Department of Critical Care, Medanta The Medicity, New Delhi, India
| | - Prasad Rajhans
- Department of Infection Prevention, Deenanath Mangeshkar Hospital And Research Center Erandwane Pune, Pune, India
| | | | - Tai Chian-Wern
- Department of Infection Prevention, Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | - Chin Seng Gan
- Department of Infection Prevention, University Malaya Medical Centre Pediatric Intensive Care, Kuala Lumpur, Malaysia
| | - Mat Nor Mohd-Basri
- Department of Infection Prevention, International Islamic University Malaysia Department Of Anesthesia And Critical Care, Kuantan, Malaysia
| | - Guadalupe Aguirre-Avalos
- Department of Critical Care, Hospital Civil De Guadalajara Fray Antonio Alcalde Terapia Intensiva, Guadalajara, Mexico
| | - Blanca E Hernandez-Chena
- Department of Infection Prevention, Hospital General Regional 6 De Ciudad Madero, Madero, Mexico
| | - Alejandro Sassoe-Gonzalez
- Department of Infection Prevention, Hospital Regional De Alta Especialidad De Ixtapaluca, Ixtapaluca, Mexico
| | - Isabel Villegas-Mota
- Department of Infection Prevention, Instituto Nacional De Perinatologia Unidad De Cuidados Intensivos Neonatales, Mexico City, Mexico
| | - Mary C Aleman-Bocanegra
- Department of Infection Prevention, Hospital San José De Monterrey Nuevo Leon, Monterrey, Nuevo Leon, Mexico
| | - Ider Bat-Erdene
- Department of Infection Prevention, Intermed Hospital, Ulaanbaatar, Mongolia
| | - Nilton Y Carreazo
- Department of Infection Prevention, Universidad Peruana de Ciencias Aplicadas, Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | - Sona Hlinkova
- Department of Infection Prevention, Catholic University In Ruzomberok Faculty Of Health Central Military Hospital Snp Ruzomberok, Ruzomberok, Slovakia
| | - Dincer Yildizdas
- Department of Infection Prevention, Balcali Hospital Pediatric Intensive Care Unit, Adana, Turkey
| | - Merve Havan
- Department of Infection Prevention, Ankara University Faculty Of Medicine, Ankara, Turkey
| | - Alper Koker
- Department of Infection Prevention, Akdeniz University Medical School, Antalya, Turkey
| | - Hulya Sungurtekin
- Department of Infection Prevention, Pamukkale University Hospital, Denizli, Turkey
| | - Ener C Dinleyici
- Department of Infection Prevention, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Ertugrul Guclu
- Department of Infection Prevention, Sakarya University Training And Research Hospital, Sakarya, Turkey
| | - Lili Tao
- Department of Infection Prevention, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ziad A Memish
- Department of Infection Prevention, King Saud Medical City, Ministry of Health, Riyadh, Arabia
| | - Ruijie Yin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Alwazzeh MJ, Alnimr A, Al Nassri SA, Alwarthan SM, Alhajri M, AlShehail BM, Almubarak M, Alghamdi NS, Wali HA. Microbiological trends and mortality risk factors of central line-associated bloodstream infections in an academic medical center 2015-2020. Antimicrob Resist Infect Control 2023; 12:128. [PMID: 37981696 PMCID: PMC10659071 DOI: 10.1186/s13756-023-01338-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 11/21/2023] Open
Abstract
BACKGROUND Despite tremendous efforts to prevent central line-associated bloodstream infections, they still remain life-threatening complications among hospitalized patients with significant morbidity and mortality worldwide. The emerging antibiotic-resistant bacteria and other risk factors, including patient comorbidities, complicate patient management. METHODS A single-center retrospective observational study was conducted at King Fahad Hospital of the University, Eastern Province, Saudi Arabia. Hospitalized patients with confirmed central line-associated bloodstream infections between January 2015 and December 2020 were included. The primary objectives were to investigate the trends in antibiotic susceptibility patterns of the causative agents, coexisting comorbid conditions, and other risk factors associated with mortality. RESULTS A total of 214 patients with confirmed central line-associated bloodstream infections were included (CLABSI). The overall 30-day mortality rate was 33.6%. The infection rates per 1000 central line days for medical, surgical, and pediatric intensive care units were 4.97, 2.99, and 4.56 per 1000 CL days, respectively. The overall microbiological trends showed a predominance of Gram-negative agents, a steady increase of fungal CLABSI up to 24.0% in 2020, and a high prevalence of multidrug resistance up to 47% of bacterial CLABSI. In addition, the study indicates a significant negative surviving correlation with diabetes mellitus, cardiovascular disease, lung disease, chronic kidney disease, and the presence of ≥ 3 comorbidities (P < 0.05). CONCLUSION The microbiological trends of the study population demonstrated a steady increase of CLABSI caused by Candida spp. with a predominance of Gram-negative pathogens. Stratifying the patients according to relevant mortality risk factors, including patient comorbidities, will help reduce CLABSI rates and improve patient outcomes.
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Affiliation(s)
- Marwan Jabr Alwazzeh
- Infectious Disease Division, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Dammam, Al-Khobar, Saudi Arabia.
| | - Amani Alnimr
- Department of Microbiology, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Samia A Al Nassri
- Infection Control Unit, King Fahad Hospital of the University, Al-Khobar, Saudi Arabia
| | - Sara M Alwarthan
- Infectious Disease Division, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Dammam, Al-Khobar, Saudi Arabia
| | - Mashael Alhajri
- Infectious Disease Division, Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Dammam, Al-Khobar, Saudi Arabia
| | - Bashayer M AlShehail
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mahdi Almubarak
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nada S Alghamdi
- Department of Microbiology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Haytham A Wali
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al- Ahsa, Saudi Arabia
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5
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Rosenthal VD, Yin R, Myatra SN, Memish ZA, Rodrigues C, Kharbanda M, Valderrama-Beltran SL, Mehta Y, Afeef Al-Ruzzieh M, Aguirre-Avalos G, Guclu E, Gan CS, Jiménez Alvarez LF, Chawla R, Hlinkova S, Arjun R, Agha HM, Zuniga Chavarria MA, Davaadagva N, Lai YH, Gomez K, Aguilar-de-Moros D, Tai CW, Sassoe Gonzalez A, Aguilar Moreno LA, Sandhu K, Janc J, Aleman Bocanegra MC, Yildizdas D, Cano Medina YA, Villegas Mota MI, Omar AA, Duszynska W, El-Kholy AA, Alkhawaja SA, Florin GH, Medeiros EA, Tao L, Tumu N, Elanbya MG, Dongol R, Mioljević V, Raka L, Dueñas L, Carreazo NY, Dendane T, Ikram A, Kardas T, Petrov MM, Bouziri A, Viet-Hung N, Belskiy V, Elahi N, Salgado E, Jin Z. 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. Infect Control Hosp Epidemiol 2023:1-11. [PMID: 37114756 DOI: 10.1017/ice.2023.69] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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.
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Affiliation(s)
- Victor Daniel Rosenthal
- 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
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
| | | | - Ziad A Memish
- King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia
| | - Camilla Rodrigues
- Pd Hinduja National Hospital And Medical Research Centre, Mumbai, India
| | | | | | | | | | - Guadalupe Aguirre-Avalos
- Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico
- Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, Mexico
| | - Ertugrul Guclu
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Chin Seng Gan
- University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | | | | | - Sona Hlinkova
- Faculty of Health, Catholic University in Ruzomberok, Ruzomberok, Slovakia
- Central Military Hospital Ruzomberok, Ruzomberok, Slovakia
| | | | | | | | | | - Yin Hoong Lai
- International Islamic University Malaysia, Kuantan Pahang, Malaysia
| | | | | | - Chian-Wern Tai
- Universiti Kebangsaan Malaysia Specialist Children's Hospital, Kuala Lumpur, Malaysia
| | | | | | - Kavita Sandhu
- Max Super Speciality Hospital Saket Delhi, New Delhi, India
| | - Jarosław Janc
- Department of Anesthesiology and Intensive Therapy, 4th Clinical Military Hospital with Polyclinic, Wroclaw, Poland
| | | | | | | | | | - Abeer Aly Omar
- Infection Control Directorate. Ministry of Health, Kuwait City, Kuwait
| | - Wieslawa Duszynska
- Wroclaw Medical University. Department of Anesthesiology and Intensive Therapy, Wroclaw, Poland
| | | | | | - George Horhat Florin
- University of Medicine and Pharmacy Victor Babes, Timisoara, Romania
- Timisoara Emergency Clinical County Hospital Romania, Timisoara, Romania
| | | | - Lili Tao
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Nellie Tumu
- Port Moresby General Hospital, Port Moresby, Papua, New Guinea
| | | | | | | | - Lul Raka
- National Institute For Public Health, Prishtina, Kosovo
| | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
| | - Nilton Yhuri Carreazo
- Universidad Peruana de Ciencias Aplicadas, Lima, Peru
- Hospital de Emergencias Pediatricas, Lima, Peru
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Tala Kardas
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Michael M Petrov
- Department of Microbiology, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | | | | | | | | | - Zhilin Jin
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States
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Hafiz TA, Bin Essa EA, Alharbi SR, Alyami AS, Alkudmani ZS, Mubaraki MA, Alturki NA, Alotaibi F. Epidemiological, Microbiological, and Clinical Characteristics of Multi-Resistant Pseudomonas aeruginosa Isolates in King Fahad Medical City, Riyadh, Saudi Arabia. Trop Med Infect Dis 2023; 8:tropicalmed8040205. [PMID: 37104331 PMCID: PMC10145365 DOI: 10.3390/tropicalmed8040205] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
Increasing rates of serious multi-drug resistant (MDR) Pseudomonas aeruginosa infections have been reported globally, including in Saudi Arabia. This retrospective study investigates the epidemiological, microbiological, and clinical characteristics of multi-resistant P. aeruginosa (n3579 clinical isolates) in King Fahad Medical City, Riyadh, Saudi Arabia (2019–2021). Information on antimicrobial susceptibility and medical history was collected from the hospital database. P. aeruginosa infections occurred in 55.6% of males and 44.4% of females, and P. aeruginosa was more prevalent in children than in adults. Our analysis showed that P. aeruginosa had the highest sensitivity to amikacin (92.6%) and greatest resistance to aztreonam (29.8%), imipenem (29.5%), ceftazidime (26.1%), meropenem (25.6%), and cefepime (24.3%). MDR and extensively drug resistant (XDR) strains were more prevalent in male than female patients. Female patients showed higher rates of infection with pan-drug resistant (PDR) strains. Respiratory samples contained the majority of resistant isolates. Septic shock and liver disease were strongly correlated with mortality in the ICU patient group after analysing the relative risk associated with mortality. Our study emphasises the threat of multi-resistant P. aeruginosa in Saudi Arabia (and potentially the Middle East) and highlights important sources and contexts of infection that inhibit its effective control and clinical management.
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Affiliation(s)
- Taghreed A. Hafiz
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
- Correspondence: ; Tel.: +966-11-805-2575
| | - Eman A. Bin Essa
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Sarah R. Alharbi
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Ahmed S. Alyami
- Pathology and Clinical Laboratory Medicine, King Fahad Medical City, Riyadh 11525, Saudi Arabia
| | - Zeina S. Alkudmani
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Murad A. Mubaraki
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Norah A. Alturki
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh 12372, Saudi Arabia
| | - Fawzia Alotaibi
- Pathology Department, College of Medicine, King Saud University, Riyadh 12372, Saudi Arabia
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