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Patients in intensive care units (ICU) tend to acquire infections at a high rate. Researchers studied 10,038 intensive care patient case reports for a one-day period. A total of 4,501 (44.8%) of the patients were infected, and 2,064 (20.6%) had acquired the infection in the ICU. The most common infection was pneumonia, which occurred in 47% of the patients, followed by lower respiratory infection, urinary tract infection, and blood infection. Patients at the highest risk of contracting an infection in the ICU were patients who stayed longer than 48 hours, patients on mechanical ventilation, patients diagnosed with trauma, and those with central venous, pulmonary artery, or urinary catheterization. Sixty-two percent of the patients were on antimicrobial drugs, either as a preventive measure or as treatment. The infecting microorganisms included Enterobacteriaceae, Staphylococcus aureus, Pseudomonas aeruginosa, and fungi. Some of these infections can cause death., Objective.--To determine the prevalence of intensive care unit (ICU)--acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. Design.--A 1-day point-prevalence study. Setting.--Intensive care units in 17 countries in Western Europe, excluding coronary care units and peditric and special care infant units. Patients.--All patients (>10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports. Main Outcome Measures.--Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death. Results.--A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported microorganisms were Enterobacteriaceae (34.4%), Staphylococcus aureus (30.1%; [60% resistant to methicillin]), Pseudomonas aeruginosa (28.7%), coagulasenegative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (>48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% CI, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% CI, 1.25 to 2.41) increased the risk of ICU death. Conclusions.--ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients. (JAMA. 1995; 274:639-644)

Low gastric intramucosal pH (pHim) is associated with a high mortality rate in patients admitted to an intensive care unit (ICU). A study of 83 patients admitted to ICUs compared gastric tonometry with traditional methods of measuring tissue oxygenation. This was done to evaluate the importance of intestinal ischemia, or decreased blood supply to the intestines, as a predictor of death. Gastric pHim values at 24 hours were more predictive of survival than measurements taken on admission to an ICU. Gastric pHim was higher in survivors both on admission and after 24 hours. There were no significant differences between survivors and non-survivors in terms of oxygen delivery, cardiac index and oxygen uptake. Gastric pHim accurately predicted death in the ICU 88% of the time., Objective.--To investigate the importance of splanchnic ischemia in patients with acute circulatory failure by comparing gastric intramucosal pH as measured by tonometry with conventional methods of assessing adequacy of tissue oxygenation. Design.--Prospective cohort of patients with acute circulatory failure in first 24 hours after admission to the intensive care unit. Setting.--Two general intensive care units in London, England. Patients.--Consecutive sample of 83 patients of varying diagnostic categories that required pulmonary artery catheterization. Main Outcome Measures.--Gastric intramucosal pH and hemodynamic, oxygen transport, and metabolic variables were measured on admission and at 12 hours and 24 hours after admission. Prediction of outcome (death or survival) by each measurement was assessed by sensitivity, specificity, and logistic regression analysis. Results.--Mean 24-hour Acute Physiology and Chronic Health Evaluation (APACHE II) score was 20.3. There were significant differences in mean gastric intramucosal pH between survivors and nonsurvivors on admission and at 24 hours, (7.40 vs 7.28, 7.40 vs 7.24, respectively; P