EPIC3：全球IICU患者感染的发生率及结局横断面调查 2017

ICU（重症监护病房）一直是医院的感染重灾区，不仅源头上有重症感染患者输入，而且ICU内获得性感染发生率也居高不下。在我国，ICU内感染率是普通科室的5~10倍，感染发生率可超过25%。近日，一项旨在提供全球ICU感染流行病学及预后数据的调查结果出炉。这项研究名为EPIC III（Extended Prevalence of Infection in Intensive Care III），它是一项前瞻性、国际多中心的24小时患病率研究，涉及88个国家多达1150个中心。

中文版摘要

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 weremen [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.

    在2017年9月13日世界范围内的88个国家，1150个ICU的15202名患者的随访研究表明，54%的ICU患者存在疑似或确证的感染，70%的患者住院期间应用了抗生素，而疑似或确诊感染患者的死亡率为30%。