• TomaziniBruno MartinsBM0000-0001-6763-6132HCor Research Institute, Hospital do Coração, Rua Desembargador Eliseu Guilherme 200, 8th Floor, São Paulo, SP, 04004-030, Brazil. btomazini@hcor.com.br.Diretoria de compromisso social, Hospital Sírio-Libanês, São, BesenBruno Adler Maccagnan PinheiroBAMP0000-0002-3516-9696Diretoria de compromisso social, Hospital Sírio-Libanês, São Paulo, SP, Brazil.Brazilian Research in Intensive Care Network (BRICnet), São Paulo, Brazil.Intensive Care and Emergency Medicine, Hospi, Renato Hideo Nakagawa Santos, Antonio Paulo Nassar, Thabata Silva Veiga, Viviane Bezerra Campos, Samira Martins Tokunaga, Elton Sousa Santos, Leticia Galvão Barbante, Renato da Costa Maia, Flavia Cristina Soares Kojima, Ligia Nasi Laranjeira, Leandro Utino Taniguchi, Roberta Muriel Longo Roepke, Cristiano Augusto Franke, Luciana Coelho Sanches, Livia Maria Garcia Melro, Israel Silva Maia, de Souza DantasVicente CésVC0000-0002-1865-1704Hospital Naval Marcílio Dias, Rio de Janeiro, RJ, Brazil., Rodrigo Cruvinel Figueiredo, de Alencar FilhoMeton SoaresMS0000-0001-6281-9917Hospital Maternidade São Vicente de Paulo, Barbalha, CE, Brazil., Vivian Menezes Irineu, Wilson José Lovato, Cassio Luis Zandonai, Flávia Ribeiro Machado, Beatriz Arns, Giovanna Marsola, Viviane Cordeiro Veiga, Adriano José Pereira, Alexandre Biasi Cavalcanti, IMPACTO-MR investigators (2019 - 2023), and BRICNet.
• HCor Research Institute, Hospital do Coração, Rua Desembargador Eliseu Guilherme 200, 8th Floor, São Paulo, SP, 04004-030, Brazil. btomazini@hcor.com.br.
• Crit Care. 2025 Jan 3; 29 (1): 44.

BackgroundLimited data is available to evaluate the burden of device associated healthcare infections (HAI) [central line associated bloodstream infection (CLABSI), catheter associated urinary tract infection (CAUTI), and ventilator associated pneumonia (VAP)] in low and-middle-income countries. Our aim is to investigate the population attributable mortality fraction and the absolute mortality difference of HAI in a broad population of critically ill patients from Brazil.MethodsMulticenter cohort study from September 2019 to December 2023 with prospective individual patient data collection. VAP, CLABSI, and CAUTI were diagnosed by each center in accordance with Brazilian regulatory agency guidance. If a patient fulfilled all diagnostic criteria, he was deemed to have Confirmed HAI. An adjusted disability multistate model was used to evaluate the population attributable in-hospital mortality fraction (PAF) and the absolute in-hospital mortality difference (AMD).ResultsA total of 128,247 patients were included. 4066 (3.2%) distinct patients had at least one diagnosis of HAI (1493 CLABSI, 433 CAUTI, 2742 VAP, and 435 patients with more than one HAI) during the ICU stay. The PAF was 3.89% (95% CI 3.68-4.11%) for HAI, 2.16% (2.05-2.33%) for VAP, 1.2% (1.08-1.32%) for CLABSI, 0.11% (0.07-0.16%) for CAUTI, and 0.33% (0.26-0.4%) for ≥ 2 HAI. The AMD for HAI was 33.69% (95% CI 32.27-35.33%), 29.01% (27.15-30.98%) for VAP, 31.64% (29.3-34.81%) for CLABSI, 9.94% (3.88-15.54%) for CAUTI and 35.6% (28.93-42.99%) for ≥ 2 HAI.ConclusionsDevice-associated HAI significantly contribute to hospital mortality and impose a high excess risk of death for critically ill patients.© 2024. The Author(s).

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