Prevalence of infections among patients admitted to ICUs in Nordic countries and the Netherlands in comparison with Mediterranean countries: a report from the EPIC II study

Introduction

The prevalence of infection is high among patients admitted to the ICU and one of the main causes of mortality. The aim of this study was to determine the burden of infectious diseases in patients admitted to ICUs in Nordic countries and the Netherlands in comparison with Mediterranean countries.

Methods

The EPIC II 1-day point prevalence study of infections and demographics of critically ill patients was performed on 8 May 2007. A comparison of severity score, source of infection, co-morbidity and patient outcome was done for patients admitted to ICUs in low antibiotic resistance countries (LARC) (Denmark, Finland, the Netherlands, Norway, Sweden) and high antibiotic resistance countries (HARC) (Greece, Israel, Italy, Malta, Portugal, Spain, Turkey).

Results

The number of patients included was 2,270 in HARC and 581 in LARC. On the day of the study, 45.3% of patients in LARC were considered as infected compared with 51.6% in HARC (P = 0.007). The mean SAPS II scores were (95% CI) 32.7 (31.6 to 33.8) in LARC and 35.6 (35 to 36.2) in HARC (P < 0.001). Of all patients in LARC/HARC, 27.0%/33.9% (P = 0.002) had a respiratory infection, 10.8%/9.8% (P = 0.45) an abdominal infection, 7.2%/10.4% (P = 0.023) a blood infection, 2.8%/3.2% (P = 0.60) a skin infection, 2.1%/3.4% (P = 0.09) a catheter infection, 3.8%/6.6% (P = 0.012) a genitourinary infection and 0.7%/1.7% (P = 0.08) a CNS infection. Chronic renal failure was seen in 2.6% of patients in LARC and 7.3% in HARC (P < 0.001) and the corresponding prevalence of chronic obstructive disease was 13.4% and 20.2%, respectively (P < 0.001). Admissions were more often seen from OR/monitoring and less often from emergency rooms among patients admitted to ICUs in LARC compared with HARC. Median ICU length of stay (LOS) in LARC (IQR) was 5 days (1 to 19) and in HARC was 12 days (3 to 31) (P < 0.001). The corresponding hospital LOS was 16 days (7 to 38) and 24 days (10 to 54), respectively (P < 0.001). The ICU mortality rates in LARC/HARC were 14.9%/19.9% (P = 0.008) for all patients and for infected patients 21.2%/25.4% (P = 0.17), whereas the corresponding hospital mortality rates were 20.8%/26.7% (P = 0.005) for all patients and for infected patients 29.6%/34.3% (P = 0.16). The prevalence of MRSA was 0.8% among patients in LARC (5.8% in HARC) (P < 0.001) and the prevalence of P. aeruginosa was 9.9% and 14.0% (P = 0.07), respectively.

Conclusions

Infections and serious co-morbidities were more prevalent among patients admitted to ICUs in HARC than in LARC. This was associated with a longer stay and greater mortality in the ICU.