巴西重症监护病房中医疗保健相关感染的临床影响：一项多中心前瞻性队列研究
Clinical impact of healthcare-associated infections in Brazilian ICUs: a multicenter prospective cohort.
作者信息
Tomazini Bruno Martins, Besen Bruno Adler Maccagnan Pinheiro, Santos Renato Hideo Nakagawa, Nassar Antonio Paulo, Veiga Thabata Silva, Campos Viviane Bezerra, Tokunaga Samira Martins, Santos Elton Sousa, Barbante Leticia Galvão, da Costa Maia Renato, Kojima Flavia Cristina Soares, Laranjeira Ligia Nasi, Taniguchi Leandro Utino, Roepke Roberta Muriel Longo, Franke Cristiano Augusto, Sanches Luciana Coelho, Melro Livia Maria Garcia, Maia Israel Silva, de Souza Dantas Vicente Cés, Figueiredo Rodrigo Cruvinel, de Alencar Filho Meton Soares, Irineu Vivian Menezes, Lovato Wilson José, Zandonai Cassio Luis, Machado Flávia Ribeiro, Arns Beatriz, Marsola Giovanna, Veiga Viviane Cordeiro, Pereira Adriano José, Cavalcanti Alexandre Biasi
机构信息
HCor Research Institute, Hospital do Coração, Rua Desembargador Eliseu Guilherme 200, 8th Floor, São Paulo, SP, 04004-030, Brazil.
Diretoria de compromisso social, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
出版信息
Crit Care. 2025 Jan 3;29(1):4. doi: 10.1186/s13054-024-05203-8.
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.
背景
在低收入和中等收入国家，用于评估与设备相关的医疗保健感染（HAI）[中心静脉导管相关血流感染（CLABSI）、导尿管相关尿路感染（CAUTI）和呼吸机相关性肺炎（VAP）]负担的数据有限。我们的目的是调查巴西广大重症患者群体中HAI的人群归因死亡率和绝对死亡差异。
方法
2019年9月至2023年12月的多中心队列研究，前瞻性收集个体患者数据。各中心根据巴西监管机构的指导诊断VAP、CLABSI和CAUTI。如果患者符合所有诊断标准，则被视为确诊HAI。使用调整后的残疾多状态模型评估人群归因住院死亡率（PAF）和绝对住院死亡差异（AMD）。
结果
共纳入128247例患者。4066例（3.2%）不同患者在重症监护病房住院期间至少有一次HAI诊断（1493例CLABSI、433例CAUTI、2742例VAP和435例有不止一种HAI的患者）。HAI的PAF为3.89%（95%CI 3.68 - 4.11%），VAP为2.16%（2.05 - 2.33%），CLABSI为1.2%（1.08 - 1.32%），CAUTI为0.11%（0.07 - 0.16%），≥2种HAI为0.33%（0.26 - 0.4%）。HAI的AMD为33.69%（95%CI 32.27 - 35.33%），VAP为29.01%（27.15 - 30.98%），CLABSI为31.64%（29.3 - 34.81%），CAUTI为9.94%（3.88 - 15.54%），≥2种HAI为35.6%（28.93 - 42.99%）。
结论
与设备相关的HAI对医院死亡率有显著影响，并给重症患者带来很高的额外死亡风险。
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