Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017

Abstract

Importance: Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies.

Objective: To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide.

Design, setting, and participants: Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged ≥18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017.

Exposures: Infection diagnosis and receipt of antibiotics.

Main outcomes and measures: Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design).

Results: Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60]; P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistant Enterococcus (OR, 2.41 [95% CI, 1.43-4.06]; P = .001), Klebsiella resistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63]; P = .03), or carbapenem-resistant Acinetobacter species (OR, 1.40 [95% CI, 1.08-1.81]; P = .01) was independently associated with a higher risk of death vs infection with another microorganism.

Conclusions and relevance: 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.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Marshall reported receiving personal fees from AKPA Pharma and serving on their data and safety monitoring board; receiving personal fees from Baxter and serving on their advisory board; receiving nonfinancial support from Sphingotec and serving on their advisory board; and receiving personal fees from AM Pharma and serving as chair on their data and safety monitoring board. Dr Brazzi reported receiving personal fees from Medtronic. Dr Timsit reported receiving grants and personal fees from Merck, Pfizer, and Biomerieux and serving on their advisory boards; receiving personal fees from Paratek, Nabriva, and Medimune and serving on their advisory boards; and receiving a grant from 3M. Dr Gorordo-Delsol reported receiving personal fees from Pfizer SA CV (México). Dr De Waele reported serving as consultant to Merck Sharp & Dohme and Pfizer; and serving on speaker’s bureaus for Accelerate and Grifols (all honorariums paid to his institution). Dr Kollef reported receiving personal fees from Merck. Dr Angus reported receiving personal fees and serving as a consultant to Bristol-Myers Squibb, Bayer AG, and Ferring Pharmaceuticals Inc; owning stock in Alung Technologies Inc; having a patent pending with Ferring Pharmaceuticals Inc for Selepressin (compounds, compositions, and methods for treating sepsis); and having a patent pending with the University of Pittsburgh for proteomic biomarkers of sepsis in elderly patients. No other disclosures were reported.

Figures

Figure 1.. World Map Showing the Countries That Participated in EPIC III

The gray areas indicate no participating centers. EPIC III indicates Extended Study on Prevalence of Infection in Intensive Care III.

Figure 2.. Diagram Showing the Numbers of Centers That Contributed Patient Data and the Number of Patients With Infection

aThe division into definite, probable, or possible was not provided by the investigators for 52 patients (missing data). bCategorization was made by local investigators according to definitions from the International Sepsis Forum.