Poster presentation | Open | Published:
Prevalence of infection in German ICUs: results from the German Prevalence Study
Critical Carevolume 10, Article number: P117 (2006)
To compare prior findings from the German subgroup of the EPIC study with recent data from the German Prevalence study.
In a European 1-day-prevalence study in 1992 (EPIC), 10,038 patients in 1417 ICUs throughout Europe with 2010 patients on 268 ICUs in Germany were studied . The overall infection rate was 44.8%; community-acquired infections (CAI) were present in 13.7%, hospital-acquired infections (HAI) in 9.7%, and ICU-acquired infections (IAI) in 20.6%. A strong correlation between IAI and mortality was found, but rates of IAI varied between countries.
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. Hospitals were visited by experienced ICU physicians from SepNet's 17 regional study centers. Visits 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.
In total 1348 patients (34.7%) were infected, comparable with the prevalence of infection in German ICUs in the EPIC study (36.6%). Prevalence of CAI was 13.6% (EPIC: 11.2%), HAI 4.8% (EPIC: 8.1%) and IAI 11.4% (EPIC: 17.3%). In our study, among the 1348 patients with infections, 415 (30.8%) had severe sepsis(sevSep) or septic shock (SS). The prevalence of CAI in patients with sevSep/SS was 35.4%, HAI 19.8% and IAI 36.6%, respectively. Comparing infected patients with and without sevSep/SS, HAI and IAI were more frequent than CAI in patients with sevSep/SS (P = 0.0002). However, there was no difference in ICU mortality between sevSep/SS patients with CAI (51%), HAI (60%) and IAI (54%), respectively. In the EPIC study, the mortality of patients in German ICUs was 14.9%. However, the prevalence of sevSep/SS was not assessed.
Our findings show a lower prevalence of IAI, a higher prevalence of HAI/CAI and a substantially higher mortality rate, independent of the origin of infection, as compared with data from the German subgroup in the EPIC study. This difference may be due to different hospital sizes, as university hospitals were more frequent in the EPIC sample (35%) and ICUs participated by invitation, in contrast to our representative sample with random selection of ICUs. In order to reduce preventable infections, implementation of infection control policies should not be restricted to patients with IAI, but should include patients with CAI and HAI as well.
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This study was supported by the Federal Ministry of Education and Research (BMBF) grant number 01 KI 0106 and Lilly Deutschland GmbH.