67882 driver artpubuab oai:ddd.uab.cat:67882 doi 10.1001/jama.2009.1754 eng Vincent, Jean-Louis Université libre de Bruxelles, Erasme Hospital, Department of Intensive Care The Extended Prevalence of Infection in the ICU Study : EPIC II Premi a l'excel·lència investigadora. 2010 Context: Infection is a major cause of morbidity and mortality in intensive care units worldwide. However, there is still relatively little information about the global epidemiology of such infections. Objective: To provide an up-to-date picture of the extent and patterns of infection in intensive care units around the world. Design: One-day point prevalence study on May 8, 2007. Setting: A total of 1265 intensive care units from 76 countries. Patients: All patients present on one of the participating units on the study day. Main outcome measures: Demographic, physiologic, bacteriological, and therapeutic data were collected, along with outcome data at intensive care unit and hospital discharge. Results: On the day of the study, 51% of patients were considered to be infected. Seventy-one percent of all patients were receiving antibiotics. Sixty-four percent of infections were of respiratory origin, and 70% of infected patients had positive microbiological isolates; Gram-negative organisms were isolated from 62% of infectious episodes, Gram-positive organisms from 47%, and fungi from 19%. Gram-negative organisms were much less prevalent in North America, Europe and Oceania than in other regions. Patients who had longer intensive care unit stays prior to the study day had higher rates of infection, especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species and fungi. Intensive care unit (25 versus 11%) and hospital (33% versus 15%) mortality rates were more than double in infected than in non-infected patients (both P<0.001). In multivariable analysis, infection was independently associated with an increased risk of hospital mortality (odds ratio 1.52 [1.37-1.69], P<0.001). Conclusions: Infections are very common in contemporary intensive care unit patients, and risk of infection increases with duration of intensive care unit stay. In this large cohort, infection was independently associated with an increased risk of hospital death. Tots els drets reservats http://www.europeana.eu/rights/rr-f/ Article de fons PREI 2010 info:eu-repo/semantics/article info:eu-repo/semantics/acceptedVersion Rello, Jordi Universitat Autonoma de Barcelona, Hospital Vall d'Hebron, Critical Care Dept Marshall, John University of Toronto, St. Michael's Hospital, Interdepartmental Division of Critical Care Medicine, Department of Surgery Silva, Eliezer Hospital Israelita Albert Einstein (Sao Paolo, Brazil), Department of Intensive Care Anzueto, Antonio University of Texas Health Science Center (San Antonio, USA), Department of Pulmonary/Critical Care Martin, Claude D. Hôpital Nord (Marseille, France), Department of Anesthesiology ant Intensive Care Moreno, Rui Hospital de St Antonio dos Capuchos (Lisbon, Portugal), Department of Intensive Care Lipman, Jeffrey Royal Brisbane and Womens’ Hospital (Herston, Australia), Department of Intensive Care Sakr, Yasser Friedrich-Schiller University (Jena, Germany), Department of Anesthesiiology and Intensive Care Reinhart, Konrad Friedrich-Schiller University (Jena, Germany), Department of Anesthesiiology and Intensive Care Vol. 302, Núm. 21 (2009), p. 1-49 JAMA 0098-7484 49 241008 http://ddd.uab.cat/pub/artpub/2009/67882/PREI2010_jamav302n21.pdf Post-print 0001 49 21 302 v302n21 2009 ARTPUB PREI UAB file 0 MD5 2500df0a7527f69c6dd54bb13dd979d6 241008 PDF 1.4 filepath pub/artpub/2009/67882/PREI2010_jamav302n21.pdf disk