Prevalence and outcomes of infection among patients in intensive care units in 2017.
Open accessAbstract
IMPORTANCE: Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies. OBJECTIVE: To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide. DESIGN, SETTING, AND PARTICIPANTS: Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged ≥18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017. EXPOSURES: Infection diagnosis and receipt of antibiotics. MAIN OUTCOMES AND MEASURES: Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design). RESULTS: Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10 640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n = 3540), gram-positive microorganisms in 37% (n = 1946), and fungal microorganisms in 16% (n = 864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60]; P = .003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistant Enterococcus (OR, 2.41 [95% CI, 1.43-4.06]; P = .001), Klebsiella resistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63]; P = .03), or carbapenem-resistant Acinetobacter species (OR, 1.40 [95% CI, 1.08-1.81]; P = .01) was independently associated with a higher risk of death vs infection with another microorganism. CONCLUSIONS AND RELEVANCE: In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.
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The imperative to provide antimicrobials as early as possible must be balanced against the potential harms associated with administering unnecessary antimicrobials to patients without infection.
“The imperative to provide antimicrobials as early as possible, however, must be balanced against the potential harms associated with administering unnecessary antimicrobials to patients without infection (99, 100).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [99]
The Discussion links antibiotic-resistant infections to higher mortality and emphasizes antibiotic stewardship, but does not address the claimed balance between early treatment and harms from unnecessary treatment in patients without infection. The Limitations section says the study did not collect information on treatment appropriateness or effectiveness; searches for treatment timing and inappropriate antibiotic use found no passage establishing the claim. (LLM, conf=0.72)
Experimental — accuracy not yet measuredThe optimal duration of antimicrobial therapy for a given patient with sepsis or septic shock depends on many factors, including host, microbe, drug, and anatomical site.
“The optimal duration of antimicrobial therapy for a given patient with sepsis or septic shock depends on many factors, including host, microbe, drug, and anatomical site (Table 2) (99, 100).”
From Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. (2021) · cites this paper as [99]
The Participating Centers and Discussion passages describe diagnostic capacity, drug monitoring, antimicrobial resistance, and stewardship, but do not address how long antimicrobial therapy should last. Searches for optimal duration, host and microbe factors, and anatomical site found no passage supporting the claimed determinants of treatment duration. (LLM, conf=0.75)
Experimental — accuracy not yet measuredIn a recent large international point prevalence study, viruses were documented in less than 4% of infections.
“In a recent large international point prevalence study, viruses were documented in less than 4% of infections [133].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [133]
MRSA causes about 5% of culture-positive infections in critically ill patients.
“MRSA accounts for approximately 5% of culture-positive infections among critically ill patients [133]”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [133]
Apart from specific clinical situations such as epidemics or pandemics, viral infections are rarely the primary cause of sepsis.
“Viral infections encompass a broad spectrum of pathogens and diseases in humans but—apart from specific clinical situations such as epidemics/pandemics—are rarely the primary cause of sepsis.”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [133]
MRSA incidence varies by region, from about 2% in Western Europe to 10% in North America, and by patient-related characteristics.
“The incidence of MRSA varies, however, by region (ranging from ~ 2% in Western Europe to 10% in North America) and by patient-related characteristics [133, 136, 137].”
From Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021 (2021) · cites this paper as [133]
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- Authors
- Vincent, J.-L., Sakr, Y., Singer, M., Martin-Loeches, I., Machado, F. R., Marshall, J. C., Finfer, S., Pelosi, P., Brazzi, L., Aditianingsih, D., Timsit, J.-F., Du, B., Wittebole, X., Máca, J., Kannan, S., Gorordo-Delsol, L. A., De Waele, J. J., Mehta, Y., Bonten, M. J. M., Khanna, A. K., Kollef, M., Human, M., Angus, D. C., & for the EPIC III Investigators
- Affiliations
- Université Libre de Bruxelles (BE)
- Jena University Hospital (DE)
- University College London (GB)
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization, St James’s Hospital, Dublin, Ireland
- Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil
- St. Michael's Hospital (CA)
- UNSW Sydney (AU)
- Ospedale Policlinico San Martino (IT)
- Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT)
- University of Indonesia (ID)
- Medical and Infectious Diseases ICU, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
- Peking Union Medical College Hospital (CN)
- Cliniques Universitaires Saint-Luc (BE)
- University Hospital Ostrava (CZ)
- Department of Anaesthesia and Critical Care, SWBH Trust, Birmingham, England
- Hospital Juárez de México (MX)
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
- Medanta The Medicity (IN)
- Utrecht University (NL)
- Atrium Health Wake Forest Baptist (US)
- Washington University in St. Louis (US)
- Level l Trauma Centre, Netcare Union/Clinton Hospitals, Alberton, South Africa
- University of Pittsburgh (US)
- Corresponding author
- Vincent, Jean-Louis
- ORCID
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2020-04-21
- Volume
- 323
- Issue
- 15
- Pages
- 1478
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- PMC
- PMC7093816
- OpenAlex
- W3012868903
- Semantic Scholar
- 4036fe17ee96a0f4beae952552d479ff9c927861
- Cited by
- 1,011
- References
- 22
- Citations by year
- 2026: 158 · 2025: 186 · 2024: 205 · 2023: 188 · 2022: 147 · 2021: 99 · 2020: 27 · 2018: 1
- FWCI
- 73.50
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Ghent University Academic Bibliography (Ghent University) (submittedVersion)
- DIAL (Catholic University of Leuven) (submittedVersion, other-oa)
- Digital Access to Libraries (submittedVersion, other-oa)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- CINECA IRIS Institutial Research Information System (University of Genoa) (submittedVersion)
- UnissResearch (Università degli Studi di Sassari) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Topics
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Keywords
- infection prevalence, intensive care unit, intensive care unit infections, in-hospital mortality, Gram-negative bacteria, Gram-positive bacteria, fungal infection, antibiotic exposure, microbial cultivation, point prevalence, infection risk factors, nosocomial infections, resource allocation, infection control policy, adult patients, critically ill patients
- MeSH terms
- Adult, Anti-Bacterial Agents, Asia, Cross Infection, Cross-Sectional Studies, Humans, Intensive Care Units, Male, Middle Aged, Middle East, Prevalence
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