ORIGINAL RESEARCH
Intensive Care
doi: 10.25005/2074-0581-2026-28-1-11-21
PREDICTORS AND OUTCOMES OF HEALTHCARE-ASSOCIATED INFECTIONS IN CRITICALLY ILL PATIENTS FROM 2013 TO 2023

I.A. RUSLYAKOVA, E.Z. SHAMSUTDINOVA, K.I. SHIROKOV, E.L. LATARIYA, N.V. VASILYEVA

North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russian Federation

Objective: to identify predictors and evaluate outcomes of MDAIs in critically ill patients (CIPs).

Methods: a retrospective analysis was conducted on 2,743 patient records from the database of the North-Western State Medical University named after I.I. Mechnikov, Saint Petersburg, Russia, covering the period from 2013 to 2023. HAI cases, including catheter-associated urinary tract infections (CAUTI), catheter-related bloodstream infections (CRBSI), and ventilator-associated pneumonia (VAP), were classified according to the 2023 criteria established by the National Association of Specialists in the Control of Infectious and Non-Infectious Diseases (NAACINID).

Results: the study included 2,492 CIP. The MDAI incidence density among these patients was 3.5 per 1,000 device days. These data included incidence densities of 1.6, 4.6, and 4.3 per 1,000 device days for CRBSI, CAUTI, and VAP, respectively. From 2020 to 2021, a decrease in CAUTI and CRBSI incidence density was observed among all patients with MDAIs. In contrast, the VAP incidence density, which increased during 2020-2021, later declined. Independent predictors of MDAIs, in addition to DD, were: severe community-acquired pneumonia (sCAP) – 7.546 (3.528-16.138), p<0.001; chronic kidney disease (CKD) – 3.297 (1.947-5.583), p<0.001; score >4 on the Sequential Organ Failure Assessment (SOFA) Score – 2.669 (1.490-4.782), p=0.001.

Conclusion: independent predictors of MDAIs in CIP, in addition to DD, include a SOFA score greater than 4, sCAP, and CKD.

Keywords: Medical device-associated infections, healthcare-associated infections, predictors, critical condition, severe community-acquired pneumonia.

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References
  1. Vincent JL, Sakr Y, Singer M, Martin-Loeches I, Machado FR, Marshall JC, et al; EPIC III Investigators. Prevalence and outcomes of infection among patients in intensive care units in 20
  2. Rohm TV, Meier DT, Olefsky JM, Donath MY. Inflammation in obesity, diabetes, and related disorders. Immunity. 2022;55(1):31-55. https://doi.org/10.1016/j. immuni.2021.12.013
  3. Moriyama K, Ando T, Kotani M, Tokumine J, Nakazawa H, Motoyasu A, et al. Risk factors associated with increased incidences of catheter-related bloodstream infection. Medicine (Baltimore). 2022;101(42):e31160. https://doi.org/10.1097/ MD.0000000000031160
  4. Gouel-Cheron A, Swihart BJ, Warner S, Mathew L, Strich JR, Mancera A, et al. Epidemiology of ICU-onset bloodstream infection: Prevalence, pathogens, and risk factors among 150,948 ICU patients at 85 U.S. Hospitals. Crit Care Med. 2022;50(12):1725-36. https://doi.org/10.1097/CCM.0000000000005662
  5. Stewart S, Robertson C, Kennedy S, Kavanagh K, Haahr L, Manoukian S, et al. Personalized infection prevention and control: Identifying patients at risk of healthcare-associated infection. J Hosp Infect. 2021;114:32-42. https://doi. org/10.1016/j.jhin.2021.03.032
  6. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. J Chronic Dis. 1987;40(5):373-83. https://doi.org/10.1016/0021-9681(87)90171-8
  7. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22(7):707-10. https://doi.org/10.1007/BF01709751
  8. Wang L, Zhou KH, Chen W, Yu Y, Feng SF. Epidemiology and risk factors for nosocomial infection in the respiratory intensive care unit of a teaching hospital in China: A prospective surveillance during 2013 and 2015. BMC Infect Dis. 2019;19(1):145. https://doi.org/10.1186/s12879-019-3772-2
  9. Зуева ЛП, Асланов БИ, Васильев К., Иванова ТГ, Высоцкий ВС. Эпидемиоло- гическая диагностика – основа риск-ориентированных технологий профи- лактики госпитальных инфекций. Эпидемиология и вакцинопрофилактика. 2017;16(5):69-74. https://doi.org/10.31631/2073-3046-2017-16-5-69-74
  10. Rosenthal VD, Duszynska W, Ider BE, Gurskis V, Al-Ruzzieh MA, Myatra SN, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2013-2018, Adult and Pediatric Units, Device- associated Module. Am J Infect Control. 2021;49(10):1267-74. https://doi. org/10.1016/j.ajic.2021.04.077
  11. Viet Hung N, Hang PT, Rosenthal VD, Thi Anh Thu L, Thi Thu Nguyet L, Quy Chau N, et al. Multicenter study of device-associated infection rates, bacterial resistance, length of stay, and mortality in intensive care units of 2 cities of Vietnam: International Nosocomial Infection Control Consortium Findings. J Patient Saf. 2021;17(3):e222-e227. https://doi.org/10.1097/PTS.0000000000000499
  12. Menon G, Subramanian A, Baby P, Daniel N, Radhika R, George M, et al. Incidence of device associated-healthcare associated infections from a neurosurgical intensive care unit of a tertiary care center: A retrospective analysis. Anesth Es- says Res. 2020;14(3):454-60. https://doi.org/10.4103/aer.AER_112_20
  13. Rosenthal VD, Bat-Erdene I, Gupta D, Belkebir S, Rajhans P, Zand F, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary of 45 countries for 2012-2017: Device-associated module. Am J Infect Control. 2020;48(4):423-32. https://doi.org/10.1016/j.ajic.2019.08.023
  14. Afhami S, Seifi A, Hajiabdolbaghi M, Bazaz NE, Hadadi A, Hasibi M, et al. Assessment of device-associated infection rates in teaching hospitals in Islamic Republic of Iran. East Mediterr Health J. 2019;25(2):90-7. https://doi. org/10.26719/emhj.18.015
  15. Duszynska W, Rosenthal VD, Szczesny A, Zajaczkowska K, Fulek M, Tomaszewski J. Device associated-health care associated infections monitoring, prevention and cost assessment at intensive care unit of University Hospital in Poland (2015- 2017). BMC Infect Dis. 2020;20(1):761. https://doi.org/10.1186/s12879-020- 05482-w
  16. Iordanou S, Papathanassoglou E, Middleton N, Palazis L, Timiliotou-Matsentidou C, Raftopoulos V. Device-associated health care-associated infections: The effectiveness of a 3-year prevention and control program in the Republic of Cyprus. Nurs Crit Care. 2022;27(4):602-11. https://doi.org/10.1111/nicc.12581
  17. Tuma P, Vieira Junior JM, Ribas E, Silva KCCD, Gushken AKF, Torelly EMS, et al; Collaborative Study Group “Saúde em Nossas Mãos”. A National Implementation Project to prevent healthcare-associated infections in intensive care units: A collaborative initiative using the breakthrough series model. Open Forum Infect Dis. 2023;10(4):ofad129. https://doi.org/10.1093/ofid/ofad129
  18. Masoudifar M, Gouya MM, Pezeshki Z, Eshrati B, Afhami S, Farzami MR, Seifi A. Health care-associated infections, including device-associated infections, and antimicrobial resistance in Iran: The national update for 2018. J Prev Med Hyg. 2022;62(4):E943-E949. https://doi.org/10.15167/2421-4248/ jpmh2021.62.4.1801
  19. Al-Tawfiq JA, Abdrabalnabi R, Taher A, Mathew S, Al-Hassan S, AlRashed H, et al. Surveillance of device associated infections in intensive care units at a Saudi Arabian Hospital, 2017-2020. J Infect Public Health. 2023;16(6):917-21. https:// doi.org/10.1016/j.jiph.2023.04.007
  20. Ganesan V, Sundaramurthy RSr, Thiruvanamalai R, Sivakumar VA, Udayasankar S, Arunagiri R, et al. Device-associated hospital-acquired infections: Does active surveillance with bundle care offer a pathway to minimize them? Cureus. 2021;13(11):e19331. https://doi.org/10.7759/cureus.19331
  21. Zand F, Vakili H, Asmarian N, Masjedi M, Sabetian G, Nikandish R, et al. Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital. BMC Infect Dis. 2023;23(1):11. https://doi.org/10.1186/s12879-022- 07962-7
  22. Fakih MG, Bufalino A, Sturm L, Huang RH, Ottenbacher A, Saake K, et al. Coronavirus disease 2019 (COVID-19) pandemic, central-line-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI): The urgent need to refocus on hardwiring prevention efforts. Infect Control Hosp Epidemiol. 2022;43(1):26-31. https://doi.org/10.1017/ice.2021.70
  23. Fresán-Ruiz E, Pons-Tomás G, de Carlos-Vicente JC, Bustinza-Arriortua A, Slocker- Barrio M, Belda-Hofheinz S, et al, On Behalf Of The Pediatric-Envin-Helics Study Group. Device exposure and patient risk factors' impact on the healthcare- associated infection rates in PICUs. Children (Basel). 2022;9(11):1669. https:// doi.org/10.3390/children9111669
  24. AlSaleh E, Naik B, AlSaleh AM. Device-associated nosocomial infections in intensive care units at Al-Ahsa hospitals, Saudi Arabia. Cureus. 2023;15(12):e50187. https://doi.org/10.7759/cureus.50187
  25. Lafuente Cabrero E, Terradas Robledo R, Civit Cuñado A, García Sardelli D, Hidalgo López C, Giro Formatger D, et al. Risk factors of catheter-associated bloodstream infection: Systematic review and meta-analysis. PLoS One. 2023;18(3):e0282290. https://doi.org/10.1371/journal.pone.0282290
  26. Mishra SB, Misra R, Azim A, Baronia AK, Prasad KN, Dhole TN, et al. Incidence, risk factors and associated mortality of central line-associated bloodstream infections at an intensive care unit in northern India. Int J Qual Health Care. 2017;29(1):63-7. https://doi.org/10.1093/intqhc/mzw144
  27. Barbadoro P, Labricciosa FM, Recanatini C, Gori G, Tirabassi F, Martini E, et al. Catheter-associated urinary tract infection: Role of the setting of catheter insertion. Am J Infect Control. 2015;43(7):707-10. https://doi.org/10.1016/j. ajic.2015.02.011
  28. Babich T, Zusman O, Elbaz M, Ben-Zvi H, Paul M, Leibovici L, et al. Empirical antibiotic treatment does not improve outcomes in catheter-associated urinary tract infection: Prospective cohort study. Clin Infect Dis. 2017;65(11):1799-805. https://doi.org/10.1093/cid/cix680

Authors' information:

Ruslyakova Irina Anatolyevna,
Candidate of Medical Sciences, Assistant Professor of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, Head of the Department of Intensive Care for medical patients of the North-Western State Medical University named after I.I. Mechnikov
Scopus ID: 57221223010
ORCID ID: 0000-0003-1507-833X
SPIN: 3417-8804
E-mail: ruslyakova777dok@gmail.com

Shamsutdinova Elvina Zinurovna,
Intensivist of the Department of Anesthesiology and Intensive Care named after V.L. Vanevsky, Head of the Department of Intensive Care for medical patients of the North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-0003-5800-8697
SPIN: 9416-7728
E-mail: Elvina.Shamsutdinova@szgmu.ru

Shirokov Kirill Igorevich,
Graduate Student of the North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0009-0008-4787-596X
E-mail: kirillkem03@gmail.ru

Latariya Elguja Lavrentyevich,
Candidate of Medical Sciences, Associate Professor, Vice-Rector for Clinical Work, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0002-9569-8485
E-mail: Elgudzha.Latariya@szgmu.ru

Vasilyeva Natalia Vsevolodovna,
Doctor of Medical Sciences, Full Professor, Director of the Scientific Research Institute of Medical Mycology named after P.N. Kashkin, North-Western State Medical University named after I.I. Mechnikov
ORCID ID: 0000-0003-3693-5468
SPIN: 3829-4370
E-mail: Natalya.Vasileva@szgmu.ru

Information about support in the form of grants, equipment, medications

The authors did not receive financial support from manufacturers of medicines and medical equipment

Conflicts of interest: No conflict

Address for correspondence:

Ruslyakova Irina Anatolyevna
Candidate of Medical Sciences, Assistant Professor of the Department of An- esthesiology and Intensive Care named after V.L. Vanevsky, Head of the De- partment of Intensive Care for medical patients of the North-Western State Medical University named after I.I. Mechnikov

195067, Russian Federation, Saint-Petersburg, Piskarevskiy Ave., 47

Tel.: +7 (921) 9183259

E-mail: Irina.Ruslyakova@szgmu.ru


This work is licensed under a Creative Commons Attribution 4.0 International License.

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