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Rate of microbiologically proven infections among patients with severe sepsis/septic shock: results from the German prevalence study
© BioMed Central Ltd 2006
Published: 21 March 2006
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.
In a European ICU survey, 55% of community-acquired and 71% of nosocomial infections were reported to be microbiologically proven .
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.
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).
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).
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.
This study was supported by the Federal Ministry of Education and Research (BMBF) grant No: 01 KI 0106 and Lilly Deutschland GmbH.