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Results of the European Prevalence of Infection in Intensive Care (EPIC) Study

Jean-Louis Vincent, MD, PhD; David J. Bihari, MB, FRCP; Peter M. Suter, MD; Hajo A. Bruining, MD, PhD; Jane White, MRCPsych; Marie-Helene Nicolas-Chanoin, MD, PhD; Michel Wolff, MD; Robert C. Spencer, MB, MSc, FRCPath; Margaret Hemmer, MD

JAMA. 1995;274(8):639-644.

Abstract
Objective.
—To determine the prevalence of intensive care unit (ICU)—acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality.

Design.
—A 1-day point-prevalence study.

Setting.
—Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care infant units.

Patients.
—All patients (>10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports.

Main Outcome Measures.
—Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death.

Results.
—A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported microorganisms were Enterobacteriaceae (34.4%), Staphylococcus aureus (30.1%; [60% resistant to methicillin]), Pseudomonas aeruginosa (28.7%), coagulase-negative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (>48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% CI, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% CI, 1.25 to 2.41) increased the risk of ICU death.

Conclusions.
—ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients.

(JAMA. 1995;274:639-644)

Author Affiliations
EPIC International Advisory Committee

From the Department of Intensive Care, Erasme University Hospital, Brussels, Belgium (Dr Vincent); Intensive Care Services, Guy's Hospital, London, England (Dr Bihari); Department of Anaesthesiology, Hôpital Cantonal, Geneva, Switzerland (Dr Suter); Department of Surgery, Dijkzigt Hospital, Rotterdam, the Netherlands (Dr Bruining); Medical Action Communications, London, England (Dr White); Service de Bactériologie, Hôpital Ambroise Paré, Boulogne, France (Dr Nicolas-Chanoin); Service de Réanimation Médicale, Hôpital Bichat Claude-Bernard, Paris, France (Dr Wolff); Department of Bacteriology, Royal Hallamshire Hospital, Sheffield, England (Dr Spencer); and Service d'Anesthesiologie, Centre Hopitalier, Luxembourg, Luxembourg (Dr Hemmer).

Footnotes
A complete list of members of the EPIC International Advisory Committee appears at the end of this article.

Reprint requests to Department of Intensive Care, Erasme University Hospital, Route De Lennik 808,1070 Brussels, Belgium (Dr Vincent).

Concepts in Emergency and Critical Care section editor: Roger C. Bone, MD, Consulting Editor, JAMA.

Advisory Panel: Bart Chernow, MD, Baltimore, Md; David Dantzker, MD, New Hyde Park, NY; Jerrold Leiken, MD, Chicago, Ill; Joseph E. Parrillo, MD, Chicago, Ill; William J. Sibbald, MD, London, Ontario; and Jean-Louis Vincent, MD, PhD, Brussels, Belgium.

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