• Jean-Louis Vincent, Yasser Sakr, Mervyn Singer, Ignacio Martin-Loeches, Flavia R Machado, John C Marshall, Simon Finfer, Paolo Pelosi, Luca Brazzi, Dita Aditianingsih, Jean-François Timsit, Bin Du, Xavier Wittebole, Jan Máca, Santhana Kannan, Luis A Gorordo-Delsol, Jan J De Waele, Yatin Mehta, BontenMarc J MMJMDepartment of Medical Microbiology, University Medical Center, Utrecht University, Utrecht, the Netherlands., Ashish K Khanna, Marin Kollef, Mariesa Human, Derek C Angus, and EPIC III Investigators.
• Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
• JAMA. 2020 Apr 21; 323 (15): 1478-1487.

ImportanceInfection 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.ObjectiveTo provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide.Design, Setting, And ParticipantsObservational 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.ExposuresInfection diagnosis and receipt of antibiotics.Main Outcomes And MeasuresPrevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design).ResultsAmong 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [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 RelevanceIn 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.

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