The global incidence of suspected or proven infection among patients admitted to the intensive care unit (ICU) was high in September 2017, according to result of a study published in JAMA.
Infection is common and frequent among patients in the ICU and precedes the development of sepsis. In 2007, a study of similar design to its 1997 progenitor, but extended to include to ICUs worldwide (Extended Prevalence of Infection in Intensive Care [EPIC II]) was conducted. The results found, 51% of the patients had suspected or proven infection and 71% were receiving prophylactic antibiotics, therapeutic antibiotics, or both types of antibiotics.
Even with some consolidated national and international epidemiological sepsis data, there is a lack of data concentrated specifically on the underlying infections. Global and detailed data on types of infection, causative micro-organisms, and availability of diagnostic and treatment options is needed to increase and maintain awareness about the effects of infections, identify infection risk factors, aid in policy development, facilitate resource allocation, improve interventional study design, and provide a baseline where new treatments or management programs can be assessed for effectiveness over time.
Therefore, this observational, cross-sectional, 24-hour point prevalence study provided information about the prevalence and outcomes of infection and explored available ICU resources worldwide.
In total, 15,202 patients aged ³18 years who were treated at a participating ICU during a 24-hour period on 13 September 2017 were included; 1150 centers in 88 countries were included in this study. A longitudinal follow-up was performed with the final follow-up date occurring on 13 November 2017. The main outcome measure was infection prevalence. Secondary outcome measures included antibiotic exposure, all-cause mortality censored at 60 days, ICU mortality, and ICU and hospital stay lengths.
Demographics of the patients included a mean age of 61.1 years, 60.4% were men, and 99.8% had available infection data: 54% of patients had a suspected or proven infection and 22% had an ICU-acquired infection. Of the included patients, 70% received at least 1 antibiotic. Percentages of patients in the ICU with infection varied across geographic areas. For example, the percentage of ICU patients who had a suspected or proven infection was 43% in Australia compared with 60% in Asia and the Middle East.
Of the 7936 patients with a suspected or proven infection, the in-hospital mortality rate was 30%. Among patients with a definite infection, probable infection, or possible infection, the in-hospital mortality rates were 32%, 29%, and 26%, respectively. A multilevel analysis of patients with proven infections showed that compared with community-acquired infection, ICU-acquired infection was independently associated with a higher risk for in-hospital mortality (P =.003). Further, analyses showed that compared with other antibiotic-resistant microorganisms, infections with vancomycin-resistant Enterococcus spp (P =.001), and Klebsiella spp resistant to β- lactam antibiotics (including 3rd generation carbapenems and cephalosporins) (P =.03), or carbapenem-resistant Acinetobacter spp (P =.01) were associated with a higher risk for in-hospital mortality. Conversely, Streptococcus pneumoniae infections were associated with a lower risk for in-hospital mortality (P =.002).
Limitations of this study included the inability to establish or collect data on time of infection onset, infection resolution, appropriateness of treatment selection, or effectiveness of antibiotic choices due to study design. Further, the investigators noted difficulty in evaluating the differences in infection rate be region and the true association with mortality in regions with low to lower-middle gross national income per capital due to various factors (eg, living conditions, access to medical care, and local infrastructure).
Overall, the study authors concluded that, “In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.”
Vincent JL, Sakr Y, Singer M, et al. Prevalence and outcomes of infection among patients in intensive care units in 2017 [published online March 24, 2020]. JAMA. doi:10.1001/jama.2020.2717