326 International Nosocomial Infection Control Consortium report, data summary for 2003-2008: Impact of the country socio economic level and type of hospital on CAUTI rates in Adult and Pediatric ICUs of 25 limited resources countries

Friday, March 19, 2010
Grand Hall (Hyatt Regency Atlanta)
Victor D. Rosenthal , INICC, Buenos Aires, Argentina
Yasser Hussain , Shaukat Khanum Cancer Hospital and Research Centre, Lahore, Pakistan
Silom Jamulitra , Songklanagarind Hospital, Songkla, Thailand
Luís Gustavo de Oliveira Cardoso , Hospital de Clinicas de la Universidad Estadual de Campinas, Campinas, Brazil
Preeti Metha , SG Seth & KEM Hospital, Mumbai, India
Adriana Jiménez , Hospital de San José, Bogotá, Colombia
Huseyin Turgut , Pamukkale University, Denizli, Turkey
Ilham Abu Khader , Jordan University Hospital, Amman, Jordan
María Guadalupe Miranda Novales , Hospital de Pediatría CMN Siglo XXI, IMSS, Mexico City, Mexico
Josephine Anne Navoa-Ng, MD , St. Luke's Medical Center, Quezon City, Philippines
María Edelmira Cruz Saldarriaga , Hospital Nacional Adolfo Guevara Velasco,, Cusco, Peru
Amine Ali Zeggwagh , Ibn Sina, Rabat, Morocco
Humberto Guanche Garcell , Hospital Docente Clínico Quirúrgico "Joaquín Albarrán Domínguez", Havana, Cuba
Lourdes Dueñas , Hospital Nacional de Niños Benjamin Bloom, San Salvador, El Salvador
Zan Mitrev , Filip II Special Cardiosurgery Hospital, Skopje, Macedonia
Jin Ai Qin , The First Affiliated Hospital of Guangxi Medical University, Nanning, China
Vaidotas Gurskis , Kaunas University of Medicine, Children Clinic, Kaunas, Lithuania
SS Kanj , American University of Beirut Medical Center, Beirut, Lebanon
Trudell Mapp , Clínica Hospital San Fernando, Panama, Panama
Rosalía Fernández Hidalgo , Hospital Clínica Bíblica, San Jose, Costa Rica
Nejla Ben Jaballah , Hôpital d'Enfants, Tunis, Tunisia
Lul Raka , National Institute for Public Health of Kosova and Medical School, Prishtina University, Prishtina, Serbia and Montenegro
Le Thi Anh Thu , Cho Ray Hospital, Ho Chi Minh City, Vietnam
Achilleas Gikas , University Hospital of Heraklion, Heraklion, Greece
María Eugenia Guzmán Siritt , Hospital Militar Dr. Carlos Arvelo, Caracas, Venezuela
Background: CAUTI rates in limited resources countries are significantly higher than international standards of developed countries; but is it not known if the socio economic level of the limited resources country and the hospital type is associated with a different CAUTI rate.

Objective: To determine if device-associated infections (DAI)  rates in 154 intensive care units (ICUs) of 25 limited resources countries are significantly affected by the country socio-economic level (Low Income; Middle Low Income, and Middle High Income) and by the hospital type (Academic, Public or Private).

Methods: A prospective cohort, active DAI surveillance study was conducted on adult and pediatric patients admitted to 154 tertiary-care ICUs of 25 low, middle low, and middle high income countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, Greece, India, Jordan, Kosovo, Lebanon, Lithuania, Macedonia, Mexico, Morocco, Pakistan, Panama, Peru, Philippines, Salvador, Thailand, Tunisia, Turkey, Venezuela and Vietnam. The protocol, forms, and methodology  were developed by the INICC. Data collection was performed in the participating ICU. Data uploading and data analysis were conducted at INICC headquarters. DAI rates were recorded by applying the definitions of the CDC NNIS/NHSN system. Epi Info 6.04b and SPSS 16.0 were used for epidemiological and statistical data analysis.We analyzed the DAI (mechanical ventilator-associated pneumonia (VAP), central line associated bloodstream infection (CLAB), and catheter-associated urinary tract infection (CAUTI) rates by socio-economic level according to the World Bank categorization (Low income; middle low income, and middle high income) and by hospital type (Public, Academic, and Private) and compared the results calculating device associated rates per 1000 devices, and 95% confidence intervals.

Results: From January 2003 to December 2008, in this study 236,980 patients were enrolled from 25 limited resources countries. DAIs rates were calculated stratified by the socio economic level of the country, and hospital type. Overall CAUTI rate in low income countries was 17.3 CAUTIs per 1000 device-days (95% CI, 16.3-18.2); in middle-low income countries was 4.9 (95% CI, 4.5-5.2); and in middle-high income countries was 7.6 (95% CI, 7.3-7.9). Overall CAUTI rate at academic hospitals was 9.5 CAUTIs per 1000 device-days (95% CI, 9.2-9.9); at public hospitals was 8.9 (95% CI, 8.3-9.6); and at private hospitals was 3.7 (95% CI, 3.3-4.0).

Conclusions: Low income countries have significantly higher CAUTI rate than middle income countries. Private hospitals have a CAUTI rate significantly lower than public or academic hospitals. The country income and hospital type are associated with the CAUTI rates of limited resources countries.