ICU infections and all-cause hospital mortality rate
Background: Many articles have been published on sepsis and mortality in ICUs, but there are not many analyzing outcomes in patients with infections, nor types of infections. More information on the infection rate, types of infection, and possible impact on mortality should heighten awareness of infection effects, as well as guide resource allocation and help direct policy development for diagnosis and treatment.
Dr. Anna Rogozinska
Study design: 24-hour point-prevalence study with longitudinal follow-up.
Setting: ICUs in 1,150 centers in 88 countries.
Synopsis: The study included 15,202 patients who were aged 18 or older (mean, 61.6) within a 24-hour time period on Sept. 13, 2017, who were admitted to the ICU in participating centers and had documented, confirmed, or suspected infection. The investigators looked at prevalence of infection and antibiotic exposure on the study day and the main outcome measure was all cause in-hospital mortality, which was compiled 60 days later. The prevalence of suspected or proven infection in ICUs was 54% (8,135) and that of ICU-acquired infection was 22%. Of confirmed or suspected infection, 65% (5,259) had at least one positive microbiology culture. Of those cultures, 67% were gram-negative and 37% gram-positive bacteria, and 16% were fungal. 70% of ICU patients received at least one antibiotic. The in-hospital mortality rate with proven or suspected infection was 30% (2,404 of 7,936). Multilevel analysis disclosed two independent risk factors for mortality, which were ICU-acquired infections and antibiotic-resistant organisms, specifically, vancomycin-resistant Enterococcus, Klebsiella resistant to beta-lactam antibiotics, and carbapenem-resistant Acinetobacter.
Despite limitations related to being an observational study, 24-hour point evaluation, a centrally controlled database, and different geographic locations, this study elucidated the world-wide prevalence of ICU infection and high hospital-in mortality in those patients.
Bottom line: There is a high prevalence of infection in ICUs: 43%-60% depending on location. This is associated with 30% in-hospital mortality.
Citation: Vincent J-L et al. Prevalance and outcomes of infection among patients in intensive care units in 2017. JAMA. 2020 Mar 24;323(15):1478-87.
Dr. Rogozinska is a hospitalist and assistant professor of medicine at UK HealthCare, Lexington, Ky.
