[Dutch results of the European study of prevalence of infection during intensive care (EPIIC). II. Nature of the infections].

OBJECTIVE

Evaluation of the point prevalence of ICU-acquired infections, the type of infection, the bacteriological cultures and the antibiotics used.

DESIGN

Point prevalence study.

SETTING

78 Dutch ICUs, as part of ICUs in 17 West-European countries.

METHOD

Collecting data by detailed questionnaires for each patient admitted to one of the participating ICUs, on one specified day: April 29th, 1992. Follow-up lasted 6 weeks.

RESULTS

The most frequently diagnosed ICU-acquired infections were pneumonia and infections of the lower respiratory tract (together 63%), followed by urinary tract infections (16%), sepsis (16%) and wound infections (11%). The most frequently cultured pathogens were Gram-negative bacteria (92%), especially Enterobacteriaceae (34%) and Pseudomonas aeruginosa (30%), followed by Staphylococcus (37%), Enterococcus (20%) and surprisingly: 10% fungi. The most-prescribed antibiotics were the cephalosporins (30%), followed by broad-spectrum penicillins (17%), metronidazole (17%) and aminoglycosides (13%). On the day of this survey there was in the Netherlands no infection with MRSA (Methicillin Resistant Staphylococcus aureus), although gentamicin resistant coagulase-negative Staphylococcus and ciprofloxacin-resistant P. aeruginosa were present. In most of the hospitals in the Netherlands, microbiologists, infectious disease specialists (84%) and infection control nurses (51%) take part in the ICU team. Half of the hospitals use selective decontamination.

CONCLUSION

ICU-acquired infections are a real threat to the ICU patient. Despite a cautious antibiotics management in the Netherlands, resistance remains a serious problem.