Silva Eliézer, Dalfior Junior Luiz, Fernandes Haggéas da Silveira, Moreno Rui, Vincent Jean-Louis
Rev Bras Ter Intensiva. 2012 Jun;24(2):143-50.
To determine the prevalence of infections in Brazilian intensive care units and the associated mortality by analyzing the data obtained in the Extended Prevalence of Infection in Intensive Care (EPIC II) study.
EPIC II was a multicenter, international, cross-sectional prospective study of infection prevalence. It described the demographic, physiological, bacteriological, and therapeutic characteristics, outcome up to the 60th day, prevalence of infection, and mortality of all the patients admitted to the participating ICUs between zero hour and midnight on May 8, 2007. A total of 14,414 patients were included in the original study. Of these 14,414 patients, 1,235 were Brazilian and were hospitalized in 90 Brazilian ICUs. They represent the focus of this study.
Among these 1,235 Brazilian patients, 61,6% had an infection on the day of the trial, and the lungs were the main site of infection (71.2%). Half of the patients had positive cultures, predominantly gram-negative bacilli (72%). On the day of the study, the median SOFA score was 5 (3-8) and the median SAPS II score was 36 (26-47). The infected patients had SOFA scores significantly higher than those of the non-infected patients 6 (4-9) and 3 (2-6), respectively). The overall ICU mortality rate was 28.4%: 37.6% in the infected patients, and 13.2% in the non-infected patients (p<0.001). Similarly, the in-hospital mortality rate was 34.2%, with a higher rate in the infected than in the non-infected patients (44.2% vs. 17.7%) (p<0.001). In the multivariate analysis, the main factors associated with infection incidence were emergency surgery (OR 2.89, 95%CI [1.72-4.86], p<0.001), mechanical ventilation (OR 2.06, 95% CI [1.5-2.82], p<0.001), and the SAPS II score (OR 1.04, 95% CI [1.03-1.06], p<0.001). The main factors related to mortality were ICC functional class III/ IV (OR 3.0, 95% CI [1.51-5.98], p<0.01), diabetes mellitus (OR 0.48, 95% CI [0.25-0.95], p<0.03), cirrhosis (OR 4.62, 95% CI [1.47-14,5], p<0.01), male gender (OR 0.68, 95% CI [0.46-1.0], p<0.05), mechanical ventilation (OR 1.87, 95% CI [1.19-2.95], p<0.01), hemodialysis (OR 1.98, 95% CI [1.05-3.75], p<0.03), and the SAPS II score (OR 1.08, 95% CI [1.06-1.10], p<0.001).
The present study revealed a higher prevalence of infections in Brazilian ICUs than has been previously reported. There was a clear association between infection and mortality.
通过分析重症监护病房感染扩展患病率（EPIC II）研究中获得的数据，确定巴西重症监护病房感染的患病率及其相关死亡率。
EPIC II是一项关于感染患病率的多中心、国际性、横断面前瞻性研究。它描述了2007年5月8日零时到午夜期间入住参与研究的重症监护病房的所有患者的人口统计学、生理学、细菌学和治疗特征、至第60天的结局、感染患病率和死亡率。原始研究共纳入14414例患者。在这14414例患者中，1235例为巴西患者，在90家巴西重症监护病房住院。他们是本研究的重点。
在这1235例巴西患者中，61.6%在试验当天发生感染，肺部是主要感染部位（71.2%）。一半患者培养结果呈阳性，主要为革兰氏阴性杆菌（72%）。在研究当天，序贯器官衰竭评估（SOFA）评分中位数为5（3 - 8），简化急性生理学评分（SAPS II）中位数为36（26 - 47）。感染患者的SOFA评分显著高于未感染患者，分别为6（4 - 9）和3（2 - 6）。重症监护病房总体死亡率为28.4%：感染患者为37.6%，未感染患者为13.2%（p<0.001）。同样，住院死亡率为34.2%，感染患者高于未感染患者（44.2%对17.7%）（p<0.001）。在多变量分析中，与感染发生率相关的主要因素为急诊手术（比值比[OR]2.89，95%置信区间[CI][1.72 - 4.86]，p<0.001）、机械通气（OR 2.06，95%CI[1.5 - 2.82]，p<0.001）和SAPS II评分（OR 1.04，95%CI[1.03 - 1.06]，p<0.001）。与死亡率相关的主要因素为国际疾病分类（ICC）功能分级III/IV（OR 3.0，95%CI[1.51 - 5.98]，p<0.01）、糖尿病（OR 0.48，95%CI[0.25 - 0.95]，p<0.03）、肝硬化（OR 4.62，95%CI[1.47 - 14.5]，p<0.01）、男性（OR 0.68，95%CI[0.46 - 1.0]，p<0.05）、机械通气（OR 1.87，95%CI[1.19 - 2.95]，p<0.01）、血液透析（OR 1.98，95%CI[1.05 - 3.75]，p<0.03）和SAPS II评分（OR 1.08，95%CI[1.06 - 1.10]，p<0.001）。
本研究显示巴西重症监护病房感染患病率高于先前报道。感染与死亡率之间存在明显关联。
