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Infections Are Common in ICUs

Rate of Infection in Intensive Care Units Is About 50% Worldwide
By
WebMD Health News
Reviewed by Louise Chang, MD

Dec. 3, 2009 -- Half of patients treated in intensive care units around the globe have infections and more than two out of three are treated with antibiotics, according to a new study.

The findings raise concerns about the effectiveness of efforts to reduce hospital-acquired infections worldwide, experts tell WebMD.

The study included data from nearly 14,000 adult patients treated at nearly 1,300 ICUs in 75 countries.

Just as they had done twelve years earlier, researchers recorded the prevalence of infections and antibiotic treatment among the ICU patients during a single day in 2007.

Fifty-one percent of ICU patients had infections and 71% were being treated with antibiotics, compared to 45% and 62%, respectively, in the 1995 analysis.

The new research appears in this week's edition of The Journal of the American Medical Association.

 "It is clear the frequency of infections in intensive care units is increasing, but this is due to a number of factors," study researcher Jean-Louis Vincent, MD, PhD, of Brussels, Belgium's Erasme Hospital tells WebMD.

"We are treating more patients who are older and sicker and who are on immunosuppressive therapies. These patients are more likely to enter hospitals with infections. But despite all of our efforts, it is also clear we need to do more to prevent [hospital-acquired] infections."

More Infections With Longer ICU Stays

Among the other major findings:

  • Infected patients were more than twice as likely to die while still being treated in the ICU than non-infected patients (25% vs. 11%). 
  • Respiratory infections were most common, accounting for 64% of all infections reported. Other infection sites included the abdomen (20%), the bloodstream (15%), and urinary tract (14%). 
  • Infection rates were higher among patients with longer ICU stays: 32% of patients hospitalized in the ICU for no more than one day were infected compared to 70% of patients treated in ICUs for more than a week.

Central and South America had the highest overall infection rates (60%) of the countries included in the study, while Africa had the lowest (46%). The single-day infection rates in North America and Western Europe were 48% and 49%, respectively.

MRSA Decline Not Seen in U.S.

Hospital-acquired MRSA (methicillin-resistant Staphylococcus aureus) has received much attention in the U.S. because the infection is so difficult to treat and appears to be increasing.

The one-day snapshot in the study found methicillin resistance to be less of a problem worldwide, however, than in the past.

The overall rate of ICU infections caused by S. aureus decreased from 30% to 20% and methicillin resistance associated with these infections decreased from 60% to 50%.

"This is one bit of good news, but it doesn't really relate to North America," Brown University infection specialist Steven M. Opal, MD, tells WebMD.

Twenty-seven percent of cultures from North American were positive for S. aureus and two-thirds of these were methicillin resistant.

In an editorial published with the study, Opal warns that the infection-related death rate among hospitalized patients will continue to increase without radical new treatments and better ways to prevent antibiotic resistance.

"A post-antibiotic era is difficult to contemplate but might become a reality unless the threat of progressive antibiotic resistance is taken seriously," he writes.

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