Infections are Common in ICUs World-Wide According to Study
The December 2 issue of JAMA reports on an international study which looked at how extensive infections are in intensive care units (ICUs). The study, involving more than 1200 ICUs in 75 countries, found that about 50 percent of the patients were considered infected. These infections are associated with an increased risk of death in the hospital.
Jean-Louis Vincent, M.D., Ph.D., of Erasme Hospital, Université libre de Bruxelles, Belgium, and colleagues conducted a study to provide an indication of the extent and patterns of infection in ICUs around the world. The Extended Prevalence of Infection in Intensive Care (EPIC II) study was a 1-day study done on May 8, 2007. On the study day, data including demographic, physiologic, bacteriological, therapeutic, and outcomes were collected for 14,414 patients in 1,265 participating ICUs from 75 countries. Analyses focused on the data from 13,796 adult (18 years or older) patients.
The researchers found that on the study day, 51% of the patients (7,087) were classified as infected and 71% were receiving antibiotics (as prophylaxis or treatment). The most common site of infection was the lungs (64%) followed by the abdomen and bloodstream.
Positive microbial isolates were found in 70% of the infected patients. Of these positive isolates, 47% were gram-positive, 62% were gram-negative, and 19% were fungal.
The more days spent in the ICU, the greater the risk of infection. The infection rate increased from 32% for patients with an ICU stay of 0 or 1 day before the day of the study to more than 70% for patients with an ICU stay of more than 7 days before the day of the study. Infections in ICU patients lengthen the ICU and hospital lengths of stay.
Once the patient is infected, the risk of death more than doubles. The ICU mortality rate of infected patients was found to be 25% compared to only 11% in non-infected patients. The hospital mortality rate was found to be 33% in infected patients compared to 15% in non-infected patients.
In examining infection rates in different areas of the world, Central and South America had the highest infection rate (60 percent) and Africa had the lowest (46 percent). Also, infection rates were related to health care expenditure, with higher rates of infection reported in countries that had a lower proportion of gross domestic product devoted to health care.
“Infection and related sepsis are the leading cause of death in noncardiac ICUs, with mortality rates that reach 60 percent and account for approximately 40 percent of total ICU expenditures,” the authors write.
“The EPIC II study demonstrates that infections remain a common problem in ICU patients,” the authors write. “These important data provide a picture of patterns of infection around the world, which can enhance understanding of global and regional differences and provide pointers to help optimize infection prophylaxis and management.”
Editorial: Antibiotic Usage and Resistance - Gaining or Losing Ground on Infections in Critically Ill Patients?; JAMA. 2009;302:2367-2368.