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Prevalence of infections in intensive care units in Mexico: a multicenter study
S P Ponce de León-Rosales1, F Molinar-Ramos, G Domínguez-Cherit
1Division of Hospital Epidemiology, Nacional de la Nutrición Salvador Zubirán, Mexico City, México. sponce@quetzal.innsz.mx
Objective:
To determine the 1-day prevalence of community-acquired, hospital-acquired, or intensive care unit (ICU)-acquired infections in Mexican ICUs. To identify associated risk factors, predominant infecting organisms, and mortality rates.
Design:
A 1-day point-prevalence study.
Setting:
A total of 254 adult ICUs in Mexico.
Patients:
Adult patients hospitalized in the participating ICUs.
Results:
A total of 895 patients were studied, of whom 521 patients (58.2%) were infected. Community-acquired infection occurred in 214 patients (23.9%), non-ICU nosocomial infection occurred in 99 patients (11.1%), and 208 patients had at least one ICU-acquired infection (23.2%; 1.45 episodes/patient). The most frequently reported ICU-acquired infections were pneumonia (39.7%), urinary tract infections (20.5%), wound infection (13.3%), and bacteremia (7.3%). The mortality rate for the ICU-acquired infections after 6 wks of follow-up was 25.5%. Multivariate regression analysis showed the following risk factors for ICU-acquired infections: neurologic failure as a primary cause of admission (odds ratio [OR], 1.697; 95% confidence interval [CI], 1.001-2.839); length of stay in ICU (OR, 1.119; 95% CI, 1.091-1.151); number of therapeutic and/or diagnostic interventions during the preceding week (OR, 1.118; 95% CI, 1.016-1.231); peripherally administered infusion of hyperosmolar solutions (OR, 6.93; 95% CI, 2.452-21.661); sedative usage in the preceding week (OR, 1.751; 95% CI, 1.183-2.602); history of an emergency surgery in the preceding month (OR, 1.875; 95% CI, 1.251-2.813). The administration of antimicrobial treatment if there was an infection decreased the risk of death (OR, 0.406; 95% CI, 0.204-0.755).
Conclusions:
Evidence of a high frequency of nosocomial infections was found, and potential risk factors for acquiring infections and mortality were identified. Mortality rates according to the hierarchy of the systemic inflammatory response syndrome in Latin American ICUs are reported.
Insights
Mexican ICUs have a high prevalence of infections, with over half of patients infected. Key risk factors for intensive care unit (ICU)-acquired infections include prolonged stays and invasive procedures, leading to significant mortality.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Epidemiology
Background:
- Nosocomial infections pose a significant threat in intensive care units (ICUs).
- Understanding the epidemiology of infections in Mexican ICUs is crucial for targeted interventions.
Purpose of the Study:
- To determine the 1-day prevalence of community-acquired, hospital-acquired, and intensive care unit (ICU)-acquired infections in Mexican ICUs.
- To identify associated risk factors, predominant pathogens, and mortality rates.
Main Methods:
- A 1-day point-prevalence study was conducted across 254 adult ICUs in Mexico.
- Data were collected on 895 adult patients, including infection status, type, and outcomes.
Main Results:
- Over half of the patients (58.2%) were infected, with ICU-acquired infections affecting 23.2%.
- Pneumonia (39.7%) was the most common ICU-acquired infection, followed by urinary tract infections (20.5%).
- Identified risk factors for ICU-acquired infections included neurologic failure, extended ICU stay, multiple interventions, hyperosmolar solution infusion, sedative use, and prior emergency surgery. Antimicrobial treatment reduced mortality risk.
Conclusions:
- A high frequency of nosocomial infections was observed in Mexican ICUs.
- Several modifiable risk factors for acquiring infections and associated mortality were identified.
- Mortality rates were analyzed in the context of the systemic inflammatory response syndrome.