Prevalence of ICU infection in South Africa and accuracy of treating physician diagnosis and treatment

Introduction

ICU infection is an important cause of morbidity and mortality. Equally, it is important to establish to what extent physicians are capable of making effective diagnoses and implement correct treatment for sepsis. A national prevalence of ICU infection study was conducted in South African ICUs to evaluate these two issues.

Methods

Approval to conduct the study was obtained from all appropriate authorities. A 1-day prevalence of sepsis study was undertaken on 16 August 2005. A proportional probability sample was determined from all ICUs in the country. Attending physicians were asked to indicate their diagnosis and treatment on the day of the study. Relevant clinical data were collected for each patient and reviewed by two independent intensivists.

Results

All units chosen agreed to participate. The 28-day hospital mortality was 58 of 248 patients (23%). The prevalence of each category of the SIRS [1] criteria and associated percentage mortality respectively was nil 59 (8%), SIRS 120 (9%), sepsis 40 (28%), severe sepsis 13 (35%) and septic shock 16 (41%). One hundred and ninety-six patients were deemed to have one of the sepsis diagnoses by the primary physician, an overdiagnosis of 51%. Antibiotic prescription and associated mortality percentage respectively were: appropriate 82 (12%) and inappropriate 100 (28%). Antibiotic therapy was changed correctly after microbiology data in 21 of 88 patients (24%). Duration of therapy was correct in 51 of 183 patients (28%).

Conclusion

The prevalence of sepsis and the associated mortality is similar to that described in other studies [1]. Physicians tend to overdiagnose sepsis. Antibiotic prescribing practices were incorrect with respect to selection, modification after microbiology data and duration of treatment. A major deficiency in diagnostic and therapeutic ability among physicians was identified in this study. Appropriate steps must be taken to remedy this deficiency.