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460 Excess Length of Stay Due to Central Line-Associated Blood Stream Infections in Intensive Care Units in Argentina, Brazil and Mexico

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Victor D. Rosenthal , INICC, Buenos Aires, Argentina
Adrian G. Barnett , Institute of Health and Biomedical Innovation & School of Public Health, Queensland University of Technology, Kelvin Grove, Australia
Nicholas Graves , Queensland University of Technology, Brisbane, Australia
Reinaldo Salomao , Santa Marcelina Hospital, Sao Paulo, Brazil
Manuel Sigfrido Rangel-Frausto , Specialties IMSS Hospital, Mexico City, Mexico
Francisco Higuera , General Hospital, Mexico City, Mexico
José Martinez Soto , Gabriel Mancera IMSS Hospital, Mexico City, Mexico
Background: Health care acquired infections (HAI) create an extra burden on patients which may increase their time spent in hospital and even their risk of death. Most previous estimates of the extra length of stay due to HAI have ignored the time-dependence of HAI and are likely to have over-estimated the extra length of stay.

Objective: To estimate the excess length of stay in an intensive care unit (ICU) due to a central line-associated blood stream infection (CLABSI), using a statistical model that accounts for the timing of infection.

Methods:   A prospective cohort, active CLABSI surveillance study was conducted in adults admitted to tertiary-care ICU s in three Latin American countries (Argentina, Brazil and Mexico). The protocol, forms, and methodology implemented were developed by the International Nosocomial Infection Control Consortium (INICC). Data collection was performed in the participating ICUs. Data uploading and data analysis were conducted at INICC headquarters. CLABSI were recorded by applying the definitions provided by the CDC NNIS system. The study included all patients admitted to the ICUs during a defined time period with a central line place for more than 24 hours. We used a multi-state approach to model the excess length of stay due to CLABSI while accounting for the competing risks of death and discharge.

Results: A cohort of 3560 patients followed for 36,806 days in 11 ICUs was studied. The average excess length of stay due to a CLABSI in Argentina varied between 2.31 days to 4.69 days; in Brazil it varied between 0.78 days to 4.28 days; and in Mexico it varied between –1.23 days to 4.06 days. A reduction in length of stay in Mexico was caused by an increased risk of death due to a CLABSI, leading to shorter times to death. Adjusting for patient age and Acute Severity of Illness Score tended to increase the estimated excess length of stay due to CLABSI.

Conclusions:

The strength of multi-state models is their ability to incorporate time-dependent exposures. In this study, CLABSI is the key time-dependent exposure as it can happen at any time during a patient’s stay. CLABSIs are associated with an excess length of ICU stay and increased risk of death. The average excess length of stay varies between ICUs, most likely due to the case-mix of admissions and differences in the ways that hospitals deal with infections.