International Study of the Prevalence and Outcomes of Infection in Intensive Care Units
- Jean-Louis Vincent, MD, PhD;
- Jordi Rello, MD;
- John Marshall, MD;
- Eliezer Silva, MD, PhD;
- Antonio Anzueto, MD;
- Claude D. Martin, MD;
- Rui Moreno, MD, PhD;
- Jeffrey Lipman, MD;
- Charles Gomersall, MD;
- Yasser Sakr, MD, PhD;
- Konrad Reinhart, MD
- for the EPIC II Group of Investigators
- Author Affiliations: Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium (Dr Vincent); Critical Care Department, Joan XXIII University Hospital, CIBERes, URV-IISPV Tarragona, Spain (Dr Rello); Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada (Dr Marshall); Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, Brazil (Dr Silva); Department of Pulmonary/Critical Care, University of Texas Health Science Center, San Antonio (Dr Anzueto); Department of Anesthesiology and Intensive Care, Hôpital Nord, Marseille, France (Dr Martin); Department of Intensive Care, Hospital de St António dos Capuchos, Centro Hospitalar de Lisboa Central, E.P.E., Lisbon, Portugal (Dr Moreno); Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane, Queensland, Australia (Dr Lipman); Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, and Prince of Wales Hospital, Shatin, Hong Kong, China (Dr Gomersall); and Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany (Drs Sakr and Reinhart).
Abstract
Context Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. However, relatively little information is available about the global epidemiology of such infections.
Objective To provide an up-to-date, international picture of the extent and patterns of infection in ICUs.
Design, Setting, and Patients The Extended Prevalence of Infection in Intensive Care (EPIC II) study, a 1-day, prospective, point prevalence study with follow-up conducted on May 8, 2007. Demographic, physiological, bacteriological, therapeutic, and outcome data were collected for 14 414 patients in 1265 participating ICUs from 75 countries on the study day. Analyses focused on the data from the 13 796 adult (>18 years) patients.
Results On the day of the study, 7087 of 13 796 patients (51%) were considered infected; 9084 (71%) were receiving antibiotics. The infection was of respiratory origin in 4503 (64%), and microbiological culture results were positive in 4947 (70%) of the infected patients; 62% of the positive isolates were gram-negative organisms, 47% were gram-positive, and 19% were fungi. Patients who had longer ICU stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The ICU mortality rate of infected patients was more than twice that of noninfected patients (25% [1688/6659] vs 11% [ 682/6352], respectively; P < .001), as was the hospital mortality rate (33% [2201/6659] vs 15% [ 942/6352], respectively; P < .001) (adjusted odds ratio for risk of hospital mortality, 1.51; 95% confidence interval, 1.36-1.68; P < .001).
Conclusions Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.
