Volume 10 Supplement 1

26th International Symposium on Intensive Care and Emergency Medicine

Open Access

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

  • F Brunkhorst1,
  • F Bloos1,
  • K Reinhart1 and
  • for the German Competence Network Sepsis1
Critical Care200610(Suppl 1):P106

https://doi.org/10.1186/cc4453

Published: 21 March 2006

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.

Declarations

Acknowledgements

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

Authors’ Affiliations

(1)
Friedrich-Schiller-University

References

  1. Alberti C: Int Care Med. 2002, 28: 108-121. 10.1007/s00134-001-1143-zView ArticleGoogle Scholar

Copyright

© BioMed Central Ltd 2006