Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017
Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017
复制标题
DOI：
10.1001/jama.2020.2717
复制
发表时间：
2020-04-21
影响因子：
120.7
通讯作者：
Angus, Derek C.
中科院分区：
文献类型：
--
作者：
Vincent, Jean-Louis;Sakr, Yasser;Angus, Derek C.
重要性 重症监护病房 (ICU) 的患者中感染很常见。有关感染类型、致病病原体和结果的当代信息可以帮助制定预防、诊断、治疗和资源分配政策，并可能有助于干预研究的设计。目的 提供有关感染流行率和结果以及全世界 ICU 可用资源的信息。设计、设置和参与者 观察性 24 小时点患病率研究，在 88 个国家的 1150 个中心进行纵向随访。纳入自 2017 年 9 月 13 日 08:00 开始的 24 小时内在参与的 ICU 接受治疗的所有成年患者（年龄 >= 18 岁）。最终随访日期为 2017 年 11 月 13 日。暴露感染诊断和接受抗生素治疗。主要成果和措施感染率和抗生素暴露（横断面设计）和全因院内死亡率（纵向设计）。结果 在 15x202f;202 名患者中（平均年龄，61.1 岁 [SD，17.3 岁]；9181 名男性 [60.4%]），感染数据可用于 15x202f;165 名（99.8%）； 8135 例（54%）疑似或确诊感染，其中 1760 例（22%）为 ICU 获得性感染。总共 10x202f；640 名患者 (70%) 接受了至少 1 种抗生素治疗。疑似或确诊感染的患者比例从澳大利亚的 43% (141/328) 到亚洲和中东的 60% (1892/3150) 不等。在8135名疑似或确诊感染的患者中，5259名（65%）至少有1次微生物培养呈阳性；在这些患者中，67% (n = 3540) 发现革兰氏阴性微生物，37% (n = 1946) 发现革兰氏阳性微生物，16% (n = 864) 发现真菌微生物。疑似或确诊感染的患者的院内死亡率为 30% (2404/7936)。在多水平分析中，与社区获得性感染相比，ICU 获得性感染与较高的死亡风险独立相关（比值比 [OR]，1.32 [95% CI，1.10-1.60]；P = .003）。在抗生素耐药微生物中，耐万古霉素肠球菌感染 (OR, 2.41 [95% CI, 1.43-4.06]; P = .001)，对 β-内酰胺类抗生素耐药的克雷伯氏菌，包括第三代头孢菌素和碳青霉烯类 (OR, 1.29 [95% CI, 1.02-1.63]; P = 0.001) .03) 或耐碳青霉烯类不动杆菌 (OR, 1.40 [95% CI, 1.08-1.81]; P = .01) 与其他微生物感染相比较高的死亡风险独立相关。结论和相关性 在 2017 年 9 月入住 ICU 的全球患者样本中，疑似或确诊感染的患病率很高，院内死亡风险很高。这项研究描述了 24 小时内国际重症监护病房接受治疗的成年患者的感染流行率和结果。问题 2017 年全球重症监护病房 (ICU) 的感染患病率和医院死亡率是多少？结果 2017 年 9 月 13 日在 88 个国家的 1150 个中心进行的 24 小时点患病率研究显示，ICU 中 54% 的患者疑似或证实感染； 70% 的患者正在接受至少一种抗生素（预防性或治疗性）。已证实或疑似感染的患者的医院死亡率为 30%。含义 在 2017 年全球 ICU 患者样本中，疑似或确诊感染的患病率为 54%。
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 15x202f;202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15x202f;165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10x202f;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 beta-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.This study characterizes the point prevalence and outcomes of infection among adult patients treated at international intensive care units during a 24-hour period.Question What was the prevalence of infection and the hospital mortality rate in intensive care units (ICUs) worldwide in 2017? Findings In a 24-hour point prevalence study conducted at 1150 centers in 88 countries on September 13, 2017, 54% of patients in the ICU had suspected or proven infection; 70% of all patients were receiving at least 1 antibiotic (prophylactic or therapeutic). Hospital mortality was 30% in patients with proven or suspected infection. Meaning Among a worldwide sample of patients in ICUs in 2017, the prevalence of suspected or proven infection was 54%.