title: International study of the prevalence and outcomes of infection in intensive care units.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors: Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium. jlvincen@ulb.ac.be
authors: Jean-Louis
authors: JL
authors: Vincent
authors: Jordi
authors: J
authors: Rello
authors: John
authors: J
authors: Marshall
authors: Eliezer
authors: E
authors: Silva
authors: Antonio
authors: A
authors: Anzueto
authors: Claude D
authors: CD
authors: Martin
authors: Rui
authors: R
authors: Moreno
authors: Jeffrey
authors: J
authors: Lipman
authors: Charles
authors: C
authors: Gomersall
authors: Yasser
authors: Y
authors: Sakr
authors: Konrad
authors: K
authors: Reinhart
mesh_terms: D000349:Africa; D000569:Americas; D001208:Asia; D005060:Europe; D005260:Female; D014943:Global Health; D005102:Health Expenditures; D017052:Hospital Mortality; D006801:Humans; D007239:Infections / Q000453:epidemiology* / Q000401:mortality; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D044349:Oceania; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D012306:Risk