Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries

Abstract

Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. From 01/01/2014 to 02/10/2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple logistic regression. Outcomes are shown as adjusted odds ratios (aOR). 29,385 patients were hospitalized during 92,956days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days.,We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, ICU type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04;p<0.0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05;p<0.0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02;p<0.0001).,ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81;p<0.0001).,CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55;p<0.0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79;p<0.0001).,PICC (aOR=1.25;95%CI=0.63-2.51;p=0.52) was not associated with CLABSI risk. The following identified CLABSIRFs are unlikely to change: facility ownership and ICU type. Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.