比利时伊拉斯梅医院Jean-Louis Vincent小组分析了2017年重症监护病房患者的感染率和结局。该研究成果发表在2020年3月24日出版的《美国医学会杂志》上。

重症监护病房（ICU）中患者感染频繁。关于感染类型、致病性病原体和结局的及时信息可帮助制定预防、诊断、治疗和资源分配的政策，并可帮助设计干预性研究。

2017年9月13日至11月13日，研究组在88个国家的1150个中心进行了一项24小时观察性患病率研究以及纵向随访。共招募了15202名ICU成年患者，平均年龄为61.1岁，60.4%为男性，99.8%的患者有感染数据；其中8135名（54%）患者疑似或确诊感染，包括1760名（22%）ICU获得性感染。

共有10640名患者（70%）至少接受了一种抗生素。疑似或确诊感染患者的比例在各国家/地区差异较大，从澳大利亚的43%到亚洲和中东的60%。在8135例怀疑或证实感染的患者中，有5259例（65%）至少1种微生物培养阳性。阳性患者中有67%检出革兰氏阴性微生物，有37%检出革兰氏阳性微生物，真菌微生物感染占16%。

怀疑或证实感染患者的院内死亡率为30%。在多级分析中，与社区获得性感染相比，ICU获得性感染与更高的死亡风险独立相关，优势比为1.32。在耐抗生素的微生物中，与其他微生物感染相比，感染耐万古霉素的肠球菌、耐β-内酰胺抗生素的克雷伯菌、耐碳青霉烯类不动杆菌属与死亡高风险有关。

总之，2017年全球ICU住院患者中疑似或确诊感染的患病率很高，且存在院内死亡的巨大风险。

附：英文原文

Title: Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017

Author: Jean-Louis Vincent, Yasser Sakr, Mervyn Singer, Ignacio Martin-Loeches, Flavia R. Machado, John C. Marshall, Simon Finfer, Paolo Pelosi, Luca Brazzi, Dita Aditianingsih, Jean-Franois Timsit, Bin Du, Xavier Wittebole, Jan Máca, Santhana Kannan, Luis A. Gorordo-Delsol, Jan J. De Waele, Yatin Mehta, Marc J. M. Bonten, Ashish K. Khanna, Marin Kollef, Mariesa Human, Derek C. Angus

Issue&Volume: 2020-03-24

Abstract: Abstract

Importance  Infection is frequent among patients in the intensive care unit (ICU). Contemporary information about the types of infections, causative pathogens, and outcomes can aid the development of policies for prevention, diagnosis, treatment, and resource allocation and may assist in the design of interventional studies.

Objective  To provide information about the prevalence and outcomes of infection and the available resources in ICUs worldwide.

Design, Setting, and Participants  Observational 24-hour point prevalence study with longitudinal follow-up at 1150 centers in 88 countries. All adult patients (aged ≥18 years) treated at a participating ICU during a 24-hour period commencing at 08:00 on September 13, 2017, were included. The final follow-up date was November 13, 2017.

Exposures  Infection diagnosis and receipt of antibiotics.

Main Outcomes and Measures  Prevalence of infection and antibiotic exposure (cross-sectional design) and all-cause in-hospital mortality (longitudinal design).

Results  Among 15202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. A total of 10640 patients (70%) received at least 1 antibiotic. The proportion of patients with suspected or proven infection ranged from 43% (141/328) in Australasia to 60% (1892/3150) in Asia and the Middle East. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; gram-negative microorganisms were identified in 67% of these patients (n=3540), gram-positive microorganisms in 37% (n=1946), and fungal microorganisms in 16% (n=864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. In a multilevel analysis, ICU-acquired infection was independently associated with higher risk of mortality compared with community-acquired infection (odds ratio [OR], 1.32 [95% CI, 1.10-1.60]; P=.003). Among antibiotic-resistant microorganisms, infection with vancomycin-resistant Enterococcus (OR, 2.41 [95% CI, 1.43-4.06]; P=.001), Klebsiella resistant to β-lactam antibiotics, including third-generation cephalosporins and carbapenems (OR, 1.29 [95% CI, 1.02-1.63]; P=.03), or carbapenem-resistant Acinetobacter species (OR, 1.40 [95% CI, 1.08-1.81]; P=.01) was independently associated with a higher risk of death vs infection with another microorganism.

Conclusions and Relevance  In a worldwide sample of patients admitted to ICUs in September 2017, the prevalence of suspected or proven infection was high, with a substantial risk of in-hospital mortality.

DOI: 10.1001/jama.2020.2717

Source: https://jamanetwork.com/journals/jama/fullarticle/2763669