Skip to main content

Rate of microbiologically proven infections among patients with severe sepsis/septic shock: results from the German prevalence study

Objectives

To examine the percentage of microbiologically proven infections (MPI) among patients with severe sepsis/septic shock with clinically suspected infection (CSI) in a large and representative sample of German ICUs.

Background

In a European ICU survey, 55% of community-acquired and 71% of nosocomial infections were reported to be microbiologically proven [1].

Design and setting

A prospective observational cross-sectional 1-day-prevalence study from 15 January 2003 to 14 January 2004. A representative random sample of 310 hospitals with 454 ICUs out of a total of 1380 German hospitals with 2075 ICUs was obtained, forming five strata according to hospital size: strata 1–4 comprised all nonuniversity hospitals with <200, 201–400, 401–600, and >600 beds, respectively, and stratum 5 comprised all university hospitals. Visits by experienced ICU physicians from SepNet's 17 regional study centers were randomly selected over a 1-year period to allow for seasonal variations.

Patients

A total of 3877 patients were screened according to the ACCP/SCCM Consensus Conference criteria. Patients with CSI needed to have evidence of an infection such as white blood cells in a normally sterile body fluid, perforated viscus, chest X-ray consistent with pneumonia and associated with purulent tracheal production, or a clinical syndrome associated with a high probability of infection (e.g. ascending cholangitis).

Results

In total 1348 patients (34.7%) were infected, 736 (54.6%) of whom had CSI and 612 (45.4%) MPI. MPI was more frequent in larger hospitals, CSI more frequent in smaller hospitals (P < 0.0001). Among infected patients, the rate of MPI was highest in university hospitals (59.0%) and lowest in hospitals with < 200 beds (33.5%), reflecting the availability of microbiological laboratories (laboratory present in 16.3% in hospitals with 400 beds and in 70.0% in hospitals with 600 beds). Among the 1348 patients with infections, 415 (30.8%) had severe sepsis or septic shock. Patients with severe sepis/septic shock more often had MPI than patients without (57.3% vs 40.1%, P < 0.0001).

Conclusion

This epidemiological study shows a low overall rate of MPI in German ICUs. This is partly due to the lack of microbiological laboratories in small and middle-sized hospitals. It underlines the need for better culture-independent laboratory methods with a faster turnaround.

References

  1. 1.

    Alberti C: Int Care Med. 2002, 28: 108-121. 10.1007/s00134-001-1143-z

    Article  Google Scholar 

Download references

Acknowledgements

This study was supported by the Federal Ministry of Education and Research (BMBF) grant No: 01 KI 0106 and Lilly Deutschland GmbH.

Author information

Affiliations

Authors

Consortia

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Brunkhorst, F., Bloos, F., Reinhart, K. et al. Rate of microbiologically proven infections among patients with severe sepsis/septic shock: results from the German prevalence study. Crit Care 10, P106 (2006). https://doi.org/10.1186/cc4453

Download citation

Keywords

  • Septic Shock
  • Severe Sepsis
  • Cholangitis
  • Nosocomial Infection
  • Microbiological Laboratory