EPIC3：全球IICU患者感染的发生率及结局横断面调查 2017

EPIC3：ICU患者感染的发生率及结局

前言

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

重要性 感染在重症监护病房（ICU）患者中经常发生，有关感染类型、病原菌和结果的当代信息可以帮助制定预防、诊断、治疗和资源分配的政策，并有助于设计干预研究。

目的了解重症监护病房（ICU）的感染率、感染转归及可利用资源。

设计、设置和参与者 对88个国家1150个中心的24小时观察点患病率研究进行纵向随访。从2017年9月13日08:00开始，在参与ICU接受治疗的所有成年患者（年龄≥18岁）均包括在内。最终随访日期为2017年11月13日。

暴露接触感染诊断和抗生素的使用。

主要结果和测量 感染率和抗生素暴露率（横断面设计）和全因住院死亡率（纵向设计）。

结果 15202例患者中，平均年龄61.1岁（标准差17.3岁），男性9181例（60.4%），有效感染数据15165例（99.8%），疑似或证实感染8135例（54%），其中重症监护病房获得性感染1760例（22%）。共有10640名患者（70%）接受了至少一种抗生素。疑似或证实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名疑似或证实感染的患者中，5259名（65%）至少有1名阳性微生物培养；其中67%的患者（n=3540）有革兰氏阴性微生物，37%（n=1946）有革兰氏阳性微生物，16%（n=864）有真菌微生物。疑似或证实感染的患者住院死亡率为30%（2404/7936）。在多水平分析中，与社区获得性感染相比，重症监护病房获得性感染与较高的死亡率风险独立相关（优势比[OR]，1.32 [95%CI, 1.10-1.60]；P=0.003）。在抗生素耐药微生物中，感染万古霉素耐药肠球菌（OR, 2.41 [95%CI, 1.43-4.06]；P=0.001），对β-内酰胺类抗生素，包括第三代头孢菌素和碳青霉烯类抗生素（OR,1.29 [95%CI, 1.02-1.63]；P=0.03）或碳青霉烯类不动杆菌（OR,1.40 [95%CI, 1.08-1.81]；P=0.01）与死亡风险和其他微生物感染的高风险独立相关。

结论和相关性 在2017年9月ICU住院患者的全球样本中，疑似或证实感染的患病率很高，存在住院死亡率的巨大风险。

英文摘要

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.

小结

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%。

本文荟萃自公众号：郑州大学第一附属医院综合ICU，只做学术交流学习使用，不做为临床指导，本文观点不代表数字重症立场。