Dec. 1, 2009 Senior citizens the most frequent
visitors to intensive care units (ICUs) got really bad news today: a
check of nearly 1,300 ICUs in 75 countries found that about half of the
patients in these units had infections associated with a risk of dying
in the hospital.
"Infection and related sepsis are the leading cause
of death in noncardiac ICUs, with mortality rates that reach 60 percent
and account for approximately 40 percent of total ICU expenditures," the
authors report in the December 2 issue of the Journal of the American
Medical Association (JAMA).
Heart attack risk jumps 2.7 times, death risk
increases by 30 percent
April 28, 2008 - What seems like a great idea - a
liquid blood substitute with a long shelf-life, that does not need
refrigeration and does not cause infection - is turning into a
nightmare.
International data related to the prevalence, risk
factors, microorganisms causing the infections and outcomes of infection
are necessary to increase awareness of the impact of infection, and to
help in the development of local and international guidelines for
diagnosis and treatment and guide resource allocation, according to
background information in the article.
However, little information has been available
about the global epidemiology of infections in ICUs.
Jean-Louis Vincent, M.D., Ph.D., of Erasme
Hospital, Universitι libre de Bruxelles, Belgium, and colleagues
conducted a study to provide an indication of the extent and patterns of
infection in ICUs around the world. The Extended Prevalence of Infection
in Intensive Care (EPIC II) study was a 1-day study (May 8, 2007), in
which data including demographic, physiologic, bacteriological,
therapeutic, and outcomes were collected on this day for 14,414 patients
in 1,265 participating ICUs from 75 countries.
Analyses focused on the data from 13,796 adult (18
years or older) patients.
The researchers found that on the day of the study,
51 percent of the patients (7,087) were classified as infected and 71
percent were receiving antibiotics (as prophylaxis or treatment).
The lungs were the most common site of infection,
accounting for 64 percent of infections, followed by the abdomen and
bloodstream.
"Seventy percent of infected patients had positive
microbial isolates: 47 percent of the positive isolates were
gram-positive, 62 percent gram-negative, and 19 percent fungal."
The authors also found a relationship between the
number of days spent in the ICU before the study day and the rate of
infection: the infection rate increased from 32 percent for patients
with an ICU stay of 0 or 1 day before the day of the study to more than
70 percent for patients with an ICU stay of more than 7 days before the
day of the study.
Infected patients had longer ICU and hospital
lengths of stay than those not infected. The ICU mortality rate of
infected patients was more than twice that of noninfected patients (25
percent vs. 11 percent), as was the hospital mortality rate (33 percent
vs. 15 percent).
In examining infection rates in different areas of
the world, Central and South America had the highest infection rate (60
percent) and Africa had the lowest (46 percent).
Also, infection rates were related to health care
expenditure, with higher rates of infection reported in countries that
had a lower proportion of gross domestic product devoted to health care.
"The EPIC II study demonstrates that infections
remain a common problem in ICU patients," the authors write. "These
important data provide a picture of patterns of infection around the
world, which can enhance understanding of global and regional
differences and provide pointers to help optimize infection prophylaxis
and management."
Editorial:Antibiotic Usage and
Resistance - Gaining or Losing Ground on Infections in Critically Ill
Patients?
In an accompanying editorial, Steven M. Opal, M.D.,
of Warren Alpert Medical School of Brown University, Providence, R.I.,
and Thierry Calandra, M.D., Ph.D., of Centre Hospitalier Universitaire
Vaudois and University of Lausanne, Switzerland, offer suggestions
regarding antibiotic usage in ICUs.
"Limiting use of antibiotics to patients with clear
evidence of infection rather than colonization is essential, and
discontinuation of antibiotics when their possible benefits have been
obtained is also critical.
New initiatives such as the use of biomarkers to
aid clinicians in the decision to discontinue unnecessary antibiotic
therapy should be encouraged. Immunotherapies and reduced reliance on
invasive diagnostic and hemodynamic monitoring techniques might also be
useful in the future.
Development of novel classes of antimicrobial
agents is sadly lacking and needs to be a major research priority. New
drugs are needed to replace the increasingly obsolete classes of
antibiotics that currently exist. A postantibiotic era' is difficult to
contemplate but might become a reality unless the threat of progressive
antibiotic resistance is taken seriously."
Keep up with the latest news for senior citizens, baby
boomers
Editorial: Antibiotic Usage and
Resistance - Gaining or Losing Ground on Infections in Critically Ill
Patients?