Prospective cohort study of incidence and risk factors for catheter-associated urinary tract infections in 145 intensive care units of 9 Latin American countries: INICC findings.

PURPOSE: Identify urinary catheter (UC)-associated urinary tract infections (CAUTI) incidence and risk factors (RF) in Latin American Countries. METHODS: From 01/01/2014 to 02/10/2022, we conducted a prospective cohort study in 145 ICUs of 67 hospitals in 35 cities in nine Latin American countries: Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama, and Peru. To estimate CAUTI incidence, we used the number of UC-days as the denominator, and the number of CAUTIs as numerator. To estimate CAUTI RFs, we analyzed the following 10 variables using multiple logistic regression: gender, age, length of stay (LOS) before CAUTI acquisition, UC-days before CAUTI acquisition, UC-device utilization (DU) ratio, UC-type, hospitalizationtype, ICU type, facility ownership, and time period. RESULTS: 31,631 patients, hospitalized for 214,669 patient-days, acquired 305 CAUTIs. The pooled CAUTI rate per 1000 UC-days was 2.58, for those using suprapubic catheters, it was 2.99, and for those with indwelling catheters, it was 2.21. The following variables were independently associated with CAUTI: age, rising risk 1% yearly (aOR = 1.01; 95% CI 1.01-1.02; p < 0.0001 female gender (aOR = 1.28; 95% CI 1.01-1.61; p = 0.04), LOS before CAUTI acquisition, rising risk 7% daily (aOR = 1.07; 95% CI 1.06-1.08; p < 0.0001, UC/DU ratio (aOR = 1.14; 95% CI 1.08-1.21; p < 0.0001, public facilities (aOR = 2.89; 95% CI 1.75-4.49; p < 0.0001. The periods 2014-2016 and 2017-2019 had significantly higher risks than the period 2020-2022. Suprapubic catheters showed similar risks as indwelling catheters. CONCLUSION: The following CAUTI RFs are unlikely to change: age, gender, hospitalization type, and facility ownership. Based on these findings, it is suggested to focus on reducing LOS, UC/DU ratio, and implementing evidence-based CAUTI prevention recommendations.

Multinational prospective cohort study of incidence and risk factors for central line-associated bloodstream infections in ICUs of 8 Latin American countries.

BACKGROUND: Our objective was to identify central line (CL)-associated bloodstream infections (CLABSI) rates and risk factors in Latin-America. METHODS: From January 1, 2014 to February 10, 2022, we conducted a multinational multicenter prospective cohort study in 58 ICUs of 34 hospitals in 21 cities in 8 Latin American countries (Argentina, Brazil, Colombia, Costa Rica, Dominican Republic, Ecuador, Mexico, Panama). We applied multiple-logistic regression. Outcomes are shown as adjusted-odds ratios (aOR). RESULTS: About 29,385 patients were hospitalized during 92,956 days, acquired 400 CLABSIs, and pooled CLABSI rate was 4.30 CLABSIs per 1,000 CL-days. We analyzed following 10 variables: Gender, age, length of stay (LOS) before CLABSI acquisition, CL-days before CLABSI acquisition, CL-device utilization (DU) ratio, CL-type, tracheostomy use, hospitalization type, intensive care unit (ICU) type, and facility ownership, Following variables were independently associated with CLABSI: LOS before CLABSI acquisition, rising risk 3% daily (aOR=1.03;95%CI=1.02-1.04; P < .0001); number of CL-days before CLABSI acquisition, rising risk 4% per CL-day (aOR=1.04;95%CI=1.03-1.05; P < .0001); publicly-owned facility (aOR=2.33;95%CI=1.79-3.02; P < .0001). ICU with highest risk was medical-surgical (aOR=2.61;95%CI=1.41-4.81; P < .0001). CL with the highest risk were femoral (aOR=2.71;95%CI=1.61-4.55; P < .0001), and internal-jugular (aOR=2.62;95%CI=1.82-3.79; P < .0001). PICC (aOR=1.25;95%CI=0.63-2.51; P = .52) was not associated with CLABSI risk. CONCLUSIONS: Based on these findings it is suggested to focus on reducing LOS, CL-days, using PICC instead of femoral or internal-jugular; and implementing evidence-based CLABSI prevention recommendations.

Multinational Prospective Cohort Study of Mortality Risk Factors in 198 ICUs of 12 Latin American Countries over 24 Years: The Effects of Healthcare-Associated Infections.

BACKGROUND: The International Nosocomial Infection Control Consortium (INICC) has found a high ICU mortality rate in Latin America. METHODS: A prospective cohort study in 198 ICUs of 96 hospitals in 46 cities in 12 Latin American countries to identify mortality risk factors (RF), and data were analyzed using multiple logistic regression. RESULTS: Between 07/01/1998 and 02/12/2022, 71,685 patients, followed during 652,167 patient-days, acquired 4700 HAIs, and 10,890 died. We prospectively collected data of 16 variables. Following 11 independent mortality RFs were identified in multiple logistic regression: ventilator-associated pneumonia (VAP) acquisition (adjusted odds ratio [aOR] = 1.17; 95% CI: 1.06-1.30; p < 0.0001); catheter-associated urinary tract infection (CAUTI) acquisition (aOR = 1.34; 95% CI: 1.15-1.56; p < 0.0001); older age, rising risk 2% yearly (aOR = 1.02; 95% CI: 1.01-1.02; p < 0.0001); longer indwelling central line(CL)-days, rising risk 3% daily (aOR = 1.03; 95% CI: 1.02-1.03; p < 0.0001); longer indwelling urinary catheter(UC)-days, rising risk 1% daily (aOR = 1.01; 95% CI: 1.01-1.26; p < 0.0001); higher mechanical ventilation (MV) (aOR = 6.47; 95% CI: 5.96-7.03; p < 0.0001) and urinary catheter-utilization ratio (aOR = 1.19; 95% CI: 1.11-1.27; p < 0.0001); lower-middle level income country (aOR = 2.94; 95% CI: 2.10-4.12; p < 0.0001); private (aOR = 1.50; 95% CI: 1.27-1.77; p < 0.0001) or public hospital (aOR = 1.47; 95% CI: 1.24-1.74; p < 0.0001) compared with university hospitals; medical hospitalization instead of surgical (aOR = 1.67; 95% CI: 1.59-1.75; p < 0.0001); neurologic ICU (aOR = 4.48; 95% CI: 2.68-7.50; p < 0.0001); adult oncology ICU (aOR = 3.48; 95% CI: 2.14-5.65; p < 0.0001); and others. CONCLUSION: Some of the identified mortality RFs are unlikely to change, such as the income level of the country, facility ownership, hospitalization type, ICU type, and age. But some of the mortality RFs we found can be changed, and efforts should be made to reduce CL-days, UC-days, MV-utilization ratio, UC-utilization ratio, and lower VAPs and CAUTI rates.

FACTORES DE RIESGO CARDIOVASCULAR EN TRABAJADORES DE UNA FUNDACION, CARTAGENA / CARDIOVASCULAR RISK FACTORS IN A FOUNDATION WORKERS, CARTAGENA

La enfermedad cardiovascular es uno de los mayores problemas de salud pública en el mundo, por ser incapacitante y costosa. Se considera un trastorno de origen multifactorial, agrupados éstos en modificables y no modificable. Identificar los factores de riesgo cardiovascular en los trabajadores de una fundación, Cartagena. Se recolectó la información a 50 trabajadores de la Fundación objeto de estudio, mediante el procedimiento STEPS recomendado por la OMS, que permite diligenciar información sociodemográfica, mediciones físicas y bioquímicas. Los resultados se presentan utilizando la estadística descriptiva. Hubo una tasa de respuesta del 99,8 % del total de los participantes. El promedio de edad de los participantes fue de 30.48 años, el 84% consume alcohol y verduras 4,54 días a la semana, bajo nivel de actividad física en el 76%; sobrepeso en el 50% y el 12% presenta obesidad grado 2, antecedentes de diabetes 44% y de hipertensión el 66%. Determinar los factores de riesgo en etapas tempranas permitirá establecer acciones encaminadas a modificar estilos de vida y a disminuir el riesgo cardiovascular en los pacientes, además de promover el trabajo multisectorial para tomar decisiones y priorizar acciones.

Cardiovascular disease is one of the major public health issues in the world, because of its disabling, and costly condition. It is considered a multifactorial disorder, grouped into modifiable and non-modifiable causes. To identify risk factors for cardiovascular disease in employees of a foundation in Cartagena. Information was collected on 50 employees of the Foundation under study, following the WHO recommended procedure, which requires sociodemographic information, and physical and biochemical measurements. The results are presented using descriptive statistics. 50 surveys were conducted, with a response rate of 99.8%. Study participants have an average age of 30.48 years old, regularly consume alcohol (84%) and vegetable 4.54 days per week, low level of physical activity (76%); 50% overweight and 12% grade 2 overweight, history of diabetes 44% and 66% hypertension. The identification of risk factors in the early stages will establish actions aimed at changing lifestyles and decrease the number of patients identified with cardiovascular risk as well as promote multisectoral work to make decisions and prioritize actions.

La prostitución más allá de mitos y creencias / The prostitution beyond myths and beliefs

El documento "La prostitución... más allá de mitos y creencias" presenta los resultados de una investigación sobre las trabajadoras sexuales, realizado por el Instituto de Investigaciones Mujer y Cambio, y la Asociación de Trabajadoras para la Educación, Salud e Integración Social TESIS. En el documento son analizado diversos aspectos sobre el trabajo que realizan las trabajadoras sexuales. Los aspectos que se abordaron en el estudio son amplios, desde la vida que tuvieron desde niñas hasta la actualidad, para una mejor comprensión de los elementos que incidieron para que ellas optaran por ejercer la prostitución; y también debido a que socialmente a las mujeres que ejercen la prostitución se les atribuye la mayor responsabilidad de la transmisión de enfermedades de transmisión sexual, el sindrome de inmunodeficiencia adquirida, así como el uso de métodos anticonceptivos y de prevención de estas enfermedades