In this week's issue of the Journal of the American Medical Association, a new study has been published on a new international picture of the extent and patterns of infection in Intensive Care Units (ICUs). According to the abstract of the study (link below), little information is available regarding global epidemiology of infections in ICUs worldwide, despite the fact that such infections are a major cause of morbidity and mortality within ICUs.

In the study, entitled "The Extended Prevalence of Infection in Intensive Care (EPIC II) study," the researchers engaged in a one-day prospective, point prevalence study with follow-up conducted on May 8, 2007. Researchers collected demographic, physiological, bacteriological, therapeutic, and outcome data on 14,414 patients in 1,265 participating ICUs in 75 countries during that 24-hour study period. The adult patients were the focus of the study.

Dr. John Marshall of St. Michael's Hospital in Toronto, Canada, and co-author of the study, stated in JAMA's report video (link below) accompanying the article, "There is an additional perhaps 10 to 15 percent mortality risk associated from acquiring an infection in an ICU; therefore strategies to try to prevent that, to treat it effectively and early assumes a substantial degree of importance when you look at this as a global health problem."
The results of the study found that in that 24-hour period, 7,087 of the 13,796 (adult) patients--over half--were considered to have an infection. In addition, 71 percent were receiving antibiotics. The infections originated in the respiratory functions in 64 percent of the cases, and microbiological culture results were positive in 70% of the infected patients. Most of the positive isolates were gram-negative bacteria, others being gram-positive bacteria and fungi.

Patients who had been staying in the ICU prior to the study day had even higher rates of infection. In particular, those longer-stay patients had infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species. The study found the ICU mortality rate of infected patients was more than twice that of non-infected patients.

The researchers concluded that infections are common in patients in contemporary ICUs, and also that the risk of infection increases with duration of ICU stay. Within the study cohort, the authors stated in the abstract, infection was independently associated with an increased risk of mortality.

The authors of the study are: Jean-Louis Vincent, M.D., Ph.D.; Jordi Rello, M.D.; John Marshall, M.D.; Eliezer Silva, M.D., Ph.D.; Antonio Anzueto, M.D.; Claude D. Martin, M.D.; Rui Moreno, M.D., Ph.D.; Jeffrey Lipman, M.D.; Charles Gomersall, M.D.; Yasser Sakr, M.D., Ph.D.; Konrad Reinhart, M.D.; for the EPIC II Group of Investigators.

Read the study abstract and watch the JAMA report video:
http://jama.ama-assn.org/current.dtl

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