JAMA：ICU患者感染事件发生率及临床结局

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).研究的主要终点为感染率、抗生素使用率和全因住院死亡率。

RESULTS Among 15 202 included patients (mean age, 61.1 years [SD, 17.3 years]; 9181 were men [60.4%]), infection data were available for 15 165 (99.8%); 8135 (54%) had suspected or proven infection, including 1760 (22%) with ICU-acquired infection. 15202名患者参与研究，平均年龄61.1岁，9181名男性，8135名（54%）已怀疑或证实存在感染，其中1760名（22%）为ICU获得性感染。A total of 10 640 patients (70%) received at least 1 antibiotic. 共有10640名（70%）患者至少接受了1种抗生素治疗。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. 不同地区感染率存在差异，其中澳大利亚最低为43%(141/328)，亚洲及中东最高为60%(1892/3150)。Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture在8135名疑似或已证实感染的患者中，5259名（65%）至少有1种微生物培养阳性; 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)其中67%的患者(n=3540)发现革兰氏阴性感染，37%的患者(n=1946)发现革兰氏阳性感染，16%的患者发现真菌感染(n=864). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection疑似或已证实感染患者住院死亡率为30%（2404/7936）. 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)在多层次分析中，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（OR：1.32）. 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在抗生素耐药微生物中，万古霉素耐药肠球菌（OR：2.41），对β-内酰胺抗生素耐药的克雷伯菌，包括第三代头孢菌素和碳青霉烯类抗生素(OR：1.29)或耐碳青霉烯类不动杆菌 (OR：1.40)感染患者的死亡风险较高.

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.全球范围内，接受ICU治疗患者疑似或证实感染风险很高，导致住院死亡率增加