Investigating the Impact of HAIs on Patient Outcomes including Morbidity, Mortality, and Length of Stay in ICU in a Tertiary Care Hospital in Karachi

Abstract

Healthcare-associated infections (HAIs) pose a significant threat to patient safety in intensive care units (ICUs), particularly in resource-limited settings. However, robust local data on their incidence and impact in major tertiary care centers in Karachi, Pakistan, is scarce. This study aimed to investigate the incidence of HAIs and quantify their impact on patient mortality, morbidity, and length of stay (LOS) in this specific context. A prospective cohort study was conducted over 12 months in the adult ICUs of two tertiary care hospitals in Karachi. All patients admitted for >48 hours were enrolled. Data was collected using CDC NHSN criteria for HAIs. Patient demographics, severity of illness (APACHE II score), infection details, microbiological results, and outcomes (mortality, complications, LOS) were analyzed. Statistical analysis employed chi-square tests, t-tests, and multivariate regression to control for confounders. Among 1,428 patients, the overall HAI incidence was 15.0%. Device-associated infection rates were high, with ventilator-associated pneumonia (VAP) being most prevalent (18.3 per 1000 ventilator-days). Multidrug-resistant gram-negative pathogens, predominantly carbapenem-resistant Acinetobacter baumannii, caused most infections. Mortality was significantly higher in the HAI group (55.6% vs. 22.2%; p<0.001), with an adjusted odds ratio of 2.85. HAIs led to significantly higher rates of septic shock and organ failure. The median ICU LOS was triple in the HAI group (18 days vs. 6 days; p<0.001). HAIs are a frequent and devastating complication in the studied ICUs, independently contributing to significantly higher mortality, morbidity, and resource utilization. The high prevalence of antimicrobial resistance exacerbates the problem. These findings underscore an urgent need for strengthened, evidence-based infection prevention and control programs to improve patient outcomes and resource allocation.