Vincent Jean-Louis, Rello Jordi, Marshall John, Silva Eliezer, Anzueto Antonio, Martin Claude D, Moreno Rui, Lipman Jeffrey, Gomersall Charles, Sakr Yasser, Reinhart Konrad
Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
JAMA. 2009 Dec 2;302(21):2323-9. doi: 10.1001/jama.2009.1754.
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.
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 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.
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).
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.
感染是全球重症监护病房（ICU）发病和死亡的主要原因。然而，关于此类感染的全球流行病学信息相对较少。
提供一份关于ICU感染范围和模式的最新国际情况。
设计、地点和患者：重症监护病房感染扩展患病率（EPIC II）研究，这是一项于2007年5月8日进行的为期1天的前瞻性现患率研究，并进行了随访。在研究日，收集了来自75个国家1265个参与研究的ICU中14414例患者的人口统计学、生理学、细菌学、治疗和结局数据。分析集中于13796例成年（>18岁）患者的数据。
在研究日当天，13796例患者中有7087例（51%）被认为受到感染；9084例（71%）正在接受抗生素治疗。4503例（64%）感染源于呼吸道，4947例（70%）感染患者的微生物培养结果呈阳性；62%的阳性分离株为革兰阴性菌，47%为革兰阳性菌，19%为真菌。在研究日前在ICU停留时间较长的患者感染率较高，尤其是耐甲氧西林金黄色葡萄球菌、不动杆菌、假单胞菌属和念珠菌属引起的感染。感染患者的ICU死亡率是非感染患者的两倍多（分别为25%[1688/6659]和11%[682/6352]；P<.001），医院死亡率也是如此（分别为33%[2201/6659]和15%[942/6352]；P<.001）（医院死亡风险的调整优势比为1.51；95%置信区间为1.36-1.68；P<.001）。
当代ICU患者中感染很常见，感染风险随ICU停留时间的延长而增加。在这个大型队列中,感染与医院死亡风险增加独立相关。
