Over Half of ICU Patients Worldwide Have Active Infections

A new study has found that 51% of patients in intensive care units (ICUs) throughout the world have infections, a strong risk factor for in-hospital death.

Researchers at Erasme University Hospital (Brussels, Belgium) and researchers worldwide participating in the Extended Prevalence of Infection in Intensive Care (EPIC II) study conducted a one-day point prevalence study of ICU infection. Starting at midnight on May 7, 2007, and continuing for 24 hours, 1,265 ICUs from 75 countries in Western Europe, Central and South America, Asia, Eastern Europe, North America, Oceania, and Africa recorded data on 13,796 adult patients, using preprinted case report forms. The ICUs were also asked to follow the patients until hospital discharge or for 60 days.

The results showed that although 51% of the patients were infected, an even higher 71% were receiving antibiotics. ICU mortality rates were 11% for noninfected patients, and 25% for infected patients. Hospital mortality followed a similar pattern--15% versus 33%, respectively. The infection rates were related to disease severity, degree of organ failure, and number of days spent in the ICU. The investigators reported that the infection rate increased from 32% for patients with an ICU stay of up to one day prior to the study day, to more than 70% for patients with an ICU stay of more than 7 days. The rate of infection was also related to the proportion of gross domestic product (GDP) that countries allocated to health care expenses. Thus, infection rates ranged from 61.9% in countries devoting less than 5% of GDP to health care, to 48% in countries where more than 9% of GDP was devoted to health care. The study was published in the December 2, 2009, issue of the Journal of the American Medical Association (JAMA).

"Clearly, multiple factors can influence the relationship between health care spending and infection rates, including national antibiotic availability and policy, infection control practices, vaccine availability and use, and public health strategies and educational programs to prevent infection,” concluded lead author Professor Jean-Louis Vincent, M.D., of the Erasme ICU.

According to the results, Central and South America had the highest infection rate at 60%, and Africa had the lowest at 46%. In-hospital mortality rates were highest in ICUs from Central and South America and Eastern Europe, and lowest in ICUs in Oceania.

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Erasme University Hospital