International Study of the Prevalence and Outcomes of Infection in Intensive Care Units
Identifieur interne : 008259 ( Main/Exploration ); précédent : 008258; suivant : 008260International Study of the Prevalence and Outcomes of Infection in Intensive Care Units
Auteurs : Jean-Louis Vincent [Belgique] ; Jordi Rello [Espagne] ; John Marshall [Canada] ; Eliezer Silva [Brésil] ; Antonio Anzueto [États-Unis] ; Claude D. Martin [France] ; Rui Moreno [Portugal] ; Jeffrey Lipman [Australie] ; Charles Gomersall [Hong Kong] ; Yasser Sakr [Allemagne] ; Konrad Reinhart [Allemagne]Source :
- JAMA, the journal of the American Medical Association [ 0098-7484 ] ; 2009.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Médecine.
English descriptors
- KwdEn :
Abstract
Context 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. Design, Setting, and Patients 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 14414 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.
Affiliations:
- Allemagne, Australie, Belgique, Brésil, Canada, Espagne, France, Hong Kong, Portugal, États-Unis
- Ontario, Provence-Alpes-Côte d'Azur, Région de Bruxelles-Capitale, État de São Paulo
- Bruxelles, Marseille, Sha Tin, São Paulo, Toronto
- Université chinoise de Hong Kong, Université de Toronto, Université libre de Bruxelles
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Martin</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Department of Anesthesiology and Intensive Care, Hôpital Nord</s1><s2>Marseille</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Moreno, Rui" sort="Moreno, Rui" uniqKey="Moreno R" first="Rui" last="Moreno">Rui Moreno</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Intensive Care, Hospital de St António dos Capuchos, Centro Hospitalar de LisboaCentral, E.P.E.</s1><s2>Lisbon</s2><s3>PRT</s3><sZ>7 aut.</sZ></inist:fA14><country>Portugal</country><wicri:noRegion>Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane</s1><s2>Queensland</s2><s3>AUS</s3><sZ>8 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Queensland</wicri:noRegion></affiliation></author><author><name sortKey="Gomersall, Charles" sort="Gomersall, Charles" uniqKey="Gomersall C" first="Charles" last="Gomersall">Charles Gomersall</name><affiliation wicri:level="4"><inist:fA14 i1="09"><s1>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, and Prince of Wales Hospital</s1><s2>Shatin</s2><s3>HKG</s3><sZ>9 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Shatin</wicri:noRegion><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University</s1><s2>Jena</s2><s3>DEU</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Friedrich-Schiller University</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author><author><name sortKey="Reinhart, Konrad" sort="Reinhart, Konrad" uniqKey="Reinhart K" first="Konrad" last="Reinhart">Konrad Reinhart</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University</s1><s2>Jena</s2><s3>DEU</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Friedrich-Schiller University</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno 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last="Vincent">Jean-Louis Vincent</name><affiliation wicri:level="4"><inist:fA14 i1="01"><s1>Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles</s1><s2>Brussels</s2><s3>BEL</s3><sZ>1 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region><settlement type="city">Bruxelles</settlement></placeName><orgName type="university">Université libre de Bruxelles</orgName></affiliation></author><author><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Critical Care Department, Joan XXIII University Hospital, CIBERes, URV-IISPV Tarragona</s1><s3>ESP</s3><sZ>2 aut.</sZ></inist:fA14><country>Espagne</country><wicri:noRegion>Critical Care Department, Joan XXIII University Hospital, CIBERes, URV-IISPV Tarragona</wicri:noRegion></affiliation></author><author><name sortKey="Marshall, John" sort="Marshall, John" uniqKey="Marshall J" first="John" last="Marshall">John Marshall</name><affiliation wicri:level="4"><inist:fA14 i1="03"><s1>Department of Surgery, Interdepartmental Division of Critical Care Medicine, University of Toronto, St Michael's Hospital</s1><s2>Toronto, Ontario</s2><s3>CAN</s3><sZ>3 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto, Ontario</wicri:noRegion><orgName type="university">Université de Toronto</orgName><placeName><settlement type="city">Toronto</settlement><region type="state">Ontario</region></placeName></affiliation></author><author><name sortKey="Silva, Eliezer" sort="Silva, Eliezer" uniqKey="Silva E" first="Eliezer" last="Silva">Eliezer Silva</name><affiliation wicri:level="3"><inist:fA14 i1="04"><s1>Department of Intensive Care, Hospital Israelita Albert Einstein</s1><s2>São Paulo</s2><s3>BRA</s3><sZ>4 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">São Paulo</settlement><region type="state">État de São Paulo</region></placeName></affiliation></author><author><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Department of Pulmonary/Critical Care, University of Texas Health Science Center</s1><s2>San Antonio</s2><s3>USA</s3><sZ>5 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>San Antonio</wicri:noRegion></affiliation></author><author><name sortKey="Martin, Claude D" sort="Martin, Claude D" uniqKey="Martin C" first="Claude D." last="Martin">Claude D. Martin</name><affiliation wicri:level="3"><inist:fA14 i1="06"><s1>Department of Anesthesiology and Intensive Care, Hôpital Nord</s1><s2>Marseille</s2><s3>FRA</s3><sZ>6 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Provence-Alpes-Côte d'Azur</region><region type="old region">Provence-Alpes-Côte d'Azur</region><settlement type="city">Marseille</settlement></placeName></affiliation></author><author><name sortKey="Moreno, Rui" sort="Moreno, Rui" uniqKey="Moreno R" first="Rui" last="Moreno">Rui Moreno</name><affiliation wicri:level="1"><inist:fA14 i1="07"><s1>Department of Intensive Care, Hospital de St António dos Capuchos, Centro Hospitalar de LisboaCentral, E.P.E.</s1><s2>Lisbon</s2><s3>PRT</s3><sZ>7 aut.</sZ></inist:fA14><country>Portugal</country><wicri:noRegion>Lisbon</wicri:noRegion></affiliation></author><author><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>Burns, Trauma and Critical Care Research Centre, University of Queensland, Brisbane</s1><s2>Queensland</s2><s3>AUS</s3><sZ>8 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Queensland</wicri:noRegion></affiliation></author><author><name sortKey="Gomersall, Charles" sort="Gomersall, Charles" uniqKey="Gomersall C" first="Charles" last="Gomersall">Charles Gomersall</name><affiliation wicri:level="4"><inist:fA14 i1="09"><s1>Department of Anesthesia and Intensive Care, The Chinese University of Hong Kong, and Prince of Wales Hospital</s1><s2>Shatin</s2><s3>HKG</s3><sZ>9 aut.</sZ></inist:fA14><country>Hong Kong</country><wicri:noRegion>Shatin</wicri:noRegion><orgName type="university">Université chinoise de Hong Kong</orgName><placeName><settlement type="city">Sha Tin</settlement></placeName></affiliation></author><author><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University</s1><s2>Jena</s2><s3>DEU</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Friedrich-Schiller University</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author><author><name sortKey="Reinhart, Konrad" sort="Reinhart, Konrad" uniqKey="Reinhart K" first="Konrad" last="Reinhart">Konrad Reinhart</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Department of Anesthesiology and Intensive Care, Friedrich-Schiller University</s1><s2>Jena</s2><s3>DEU</s3><sZ>10 aut.</sZ><sZ>11 aut.</sZ></inist:fA14><country>Allemagne</country><wicri:noRegion>Jena</wicri:noRegion><wicri:noRegion>Friedrich-Schiller University</wicri:noRegion><wicri:noRegion>Jena</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">JAMA, the journal of the American Medical Association</title><title level="j" type="abbreviated">JAMA j. Am. Med. Assoc.</title><idno type="ISSN">0098-7484</idno><imprint><date when="2009">2009</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">JAMA, the journal of the American Medical Association</title><title level="j" type="abbreviated">JAMA j. Am. Med. Assoc.</title><idno type="ISSN">0098-7484</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Epidemiology</term><term>Evolution</term><term>Infection</term><term>Intensive care unit</term><term>International</term><term>Medicine</term><term>Prevalence</term><term>Prognosis</term><term>World</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Infection</term><term>International</term><term>Monde</term><term>Prévalence</term><term>Epidémiologie</term><term>Evolution</term><term>Pronostic</term><term>Unité soin intensif</term><term>Médecine</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Context 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. Design, Setting, and Patients 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 14414 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.</div></front></TEI><affiliations><list><country><li>Allemagne</li><li>Australie</li><li>Belgique</li><li>Brésil</li><li>Canada</li><li>Espagne</li><li>France</li><li>Hong Kong</li><li>Portugal</li><li>États-Unis</li></country><region><li>Ontario</li><li>Provence-Alpes-Côte d'Azur</li><li>Région de Bruxelles-Capitale</li><li>État de São Paulo</li></region><settlement><li>Bruxelles</li><li>Marseille</li><li>Sha Tin</li><li>São Paulo</li><li>Toronto</li></settlement><orgName><li>Université chinoise de Hong Kong</li><li>Université de Toronto</li><li>Université libre de Bruxelles</li></orgName></list><tree><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Vincent, Jean Louis" sort="Vincent, Jean Louis" uniqKey="Vincent J" first="Jean-Louis" last="Vincent">Jean-Louis Vincent</name></region></country><country name="Espagne"><noRegion><name sortKey="Rello, Jordi" sort="Rello, Jordi" uniqKey="Rello J" first="Jordi" last="Rello">Jordi Rello</name></noRegion></country><country name="Canada"><region name="Ontario"><name sortKey="Marshall, John" sort="Marshall, John" uniqKey="Marshall J" first="John" last="Marshall">John Marshall</name></region></country><country name="Brésil"><region name="État de São Paulo"><name sortKey="Silva, Eliezer" sort="Silva, Eliezer" uniqKey="Silva E" first="Eliezer" last="Silva">Eliezer Silva</name></region></country><country name="États-Unis"><noRegion><name sortKey="Anzueto, Antonio" sort="Anzueto, Antonio" uniqKey="Anzueto A" first="Antonio" last="Anzueto">Antonio Anzueto</name></noRegion></country><country name="France"><region name="Provence-Alpes-Côte d'Azur"><name sortKey="Martin, Claude D" sort="Martin, Claude D" uniqKey="Martin C" first="Claude D." last="Martin">Claude D. Martin</name></region></country><country name="Portugal"><noRegion><name sortKey="Moreno, Rui" sort="Moreno, Rui" uniqKey="Moreno R" first="Rui" last="Moreno">Rui Moreno</name></noRegion></country><country name="Australie"><noRegion><name sortKey="Lipman, Jeffrey" sort="Lipman, Jeffrey" uniqKey="Lipman J" first="Jeffrey" last="Lipman">Jeffrey Lipman</name></noRegion></country><country name="Hong Kong"><noRegion><name sortKey="Gomersall, Charles" sort="Gomersall, Charles" uniqKey="Gomersall C" first="Charles" last="Gomersall">Charles Gomersall</name></noRegion></country><country name="Allemagne"><noRegion><name sortKey="Sakr, Yasser" sort="Sakr, Yasser" uniqKey="Sakr Y" first="Yasser" last="Sakr">Yasser Sakr</name></noRegion><name sortKey="Reinhart, Konrad" sort="Reinhart, Konrad" uniqKey="Reinhart K" first="Konrad" last="Reinhart">Konrad Reinhart</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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