THE PREVALENCE OF NOSOCOMIAL INFECTION IN INTENSIVE-CARE UNITS IN EUROPE - RESULTS OF THE EUROPEAN PREVALENCE OF INFECTION IN INTENSIVE-CARE (EPIC) STUDY

Objective.-To determine the prevalence of intensive care unit (ICU)-ac quired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship bet ween IOU-acquired infection and mortality. Design.-A 1-day point-preva lence study. Setting.-Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care i nfant units. Patients.-All patients (>10 years of age) occupying an IO U bed over a 24-hour period. A total of 1417 ICUs provided 10 038 pati ent case reports. Main Outcome Measures.-Rates of ICU-acquired infecti on, prescription of antimicrobials, resistance patterns of microbiolog ical isolates, and potential risk factors for IOU-acquired infection a nd death. Results.-A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower res piratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infec tion reported. Most frequently reported microorganisms were Enterobact eriaceae (34.4%), Staphylococcus aureus (30.1%; [60% resistant to meth icillin]), Pseudomonas aeruginosa (28.7%), coagulase-negative staphylo cocci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (>48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. IC U-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval [ CI], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% CI, 1.71 to 7.18), a nd bloodstream infection (OR, 1.73; 95% CI, 1.25 to 2.41) increased th e risk of ICU death. Conclusions.-ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms . The potential effects on outcome emphasize the importance of specifi c measures for infection control in critically ill patients.