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Multicenter Study
. 2025 Jan 3;29(1):4.
doi: 10.1186/s13054-024-05203-8.

Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort

Bruno Martins Tomazini  1   2   3 , Bruno Adler Maccagnan Pinheiro Besen  4   5   6 , Renato Hideo Nakagawa Santos  7 , Antonio Paulo Nassar Jr  5   8   9 , Thabata Silva Veiga  7 , Viviane Bezerra Campos  7 , Samira Martins Tokunaga  7 , Elton Sousa Santos  7 , Leticia Galvão Barbante  7 , Renato da Costa Maia  7 , Flavia Cristina Soares Kojima  7 , Ligia Nasi Laranjeira  7 , Leandro Utino Taniguchi  5   6 , Roberta Muriel Longo Roepke  5   10 , Cristiano Augusto Franke  11 , Luciana Coelho Sanches  12 , Livia Maria Garcia Melro  13   14 , Israel Silva Maia  7   5   15   16 , Vicente Cés de Souza Dantas  17 , Rodrigo Cruvinel Figueiredo  18 , Meton Soares de Alencar Filho  19 , Vivian Menezes Irineu  20 , Wilson José Lovato  21 , Cassio Luis Zandonai  16 , Flávia Ribeiro Machado  5   13 , Beatriz Arns  22 , Giovanna Marsola  23 , Viviane Cordeiro Veiga  5   24 , Adriano José Pereira  5   8 , Alexandre Biasi Cavalcanti  7   5 ; IMPACTO-MR investigators (2019 - 2023); BRICNet
Collaborators, Affiliations
Multicenter Study

Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort

Bruno Martins Tomazini et al. Crit Care. .

Abstract

Background: Limited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil.

Methods: Multicenter cohort study from September 2019 to December 2023 with prospective individual patient data collection. VAP, CLABSI, and CAUTI were diagnosed by each center in accordance with Brazilian regulatory agency guidance. If a patient fulfilled all diagnostic criteria, he was deemed to have Confirmed HAI. An adjusted disability multistate model was used to evaluate the population attributable in-hospital mortality fraction (PAF) and the absolute in-hospital mortality difference (AMD).

Results: A total of 128,247 patients were included. 4066 (3.2%) distinct patients had at least one diagnosis of HAI (1493 CLABSI, 433 CAUTI, 2742 VAP, and 435 patients with more than one HAI) during the ICU stay. The PAF was 3.89% (95% CI 3.68-4.11%) for HAI, 2.16% (2.05-2.33%) for VAP, 1.2% (1.08-1.32%) for CLABSI, 0.11% (0.07-0.16%) for CAUTI, and 0.33% (0.26-0.4%) for ≥ 2 HAI. The AMD for HAI was 33.69% (95% CI 32.27-35.33%), 29.01% (27.15-30.98%) for VAP, 31.64% (29.3-34.81%) for CLABSI, 9.94% (3.88-15.54%) for CAUTI and 35.6% (28.93-42.99%) for ≥ 2 HAI.

Conclusions: Device-associated HAI significantly contribute to hospital mortality and impose a high excess risk of death for critically ill patients.

Keywords: Attributable mortality; Bloodstream infection; Healthcare associated infection; Intensive care unit; Ventilator-associated pneumonia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board of the coordinating center HCor (IRB approval number 3,025,217) and in appointed IRBs of all participating hospitals. A waiver of informed consent was obtained given the collection of routine clinical data with no intervention from study investigators and assurance of anonymization of datasets for data analysis, in accordance with Brazilian law and current regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Population attributable mortality fraction for confirmed HAI
Fig. 2
Fig. 2
Absolute mortality difference for confirmed HAI
See this image and copyright information in PMC

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