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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.