A Global Snapshot of Infection in ICUs

Richard T. Ellison III, MD


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In This Article

Abstract and Introduction


A single-day point-prevalence study performed in 1265 ICUs worldwide found that 51% of patients were actively infected.


The epidemiology of infections in ICUs has been well studied in North America and Europe but not in the rest of the world. To address this gap, an international team of investigators organized a single-day point-prevalence study in 1265 ICUs in 75 nations, using standardized definitions of infection.

On the selected study day (May 8, 2007), there were 13,796 adult patients in the participating ICUs, with 7087 (51%) classified as having infection. Seventy-one percent of all patients were receiving antibiotics (prophylactic or therapeutic). The most frequent sites of infections were the lungs (64%), abdomen (20%), bloodstream (15%), and urinary tract (14%). Gram-negative bacteria were present in 62% of positive microbial isolates, gram-positive bacteria in 47%, and fungi in 19%. The most common pathogens were Staphylococcus aureus (20%), Pseudomonas species (20%), Candida albicans (17%), and Escherichia coli (16%); half of the S. aureus isolates were methicillin resistant.

Greater disease severity, higher degrees of organ dysfunction, and longer ICU stays were each significantly associated, in a dose-response manner, with increased risk for infection. Infected patients had higher mortality rates and longer lengths of both ICU and hospital stay than did uninfected patients. Geographic variation was seen in the prevalence of several pathogens (most strikingly, Acinetobacter species), and an inverse correlation was observed between infection rates and the percentage of national gross domestic product spent on healthcare.