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BMJ 2009; 339 doi: (Published 09 December 2009) Cite this as: BMJ 2009;339:b5310

Half of ICU patients have active infections

On the 8 May 2007, staff in 1265 intensive care units (ICUs) throughout the world sent a standardised snapshot of their current patients to a coordinating centre in Belgium, where researchers ran analyses to find out the global prevalence of ICU infections. It was very high. On the day, half of patients in participating units had documented infections (7087/13 796 (51%)), most commonly of the lung (4503/7087 (64%)), followed by abdominal, bloodstream, and urinary tract infections. Staphylococcus aureus was the leading pathogen, and half the isolates were meticillin resistant. Pseudomonas species, Eschericia coli, and fungi such as Candida were also common. Acinetobacter, an environmental pathogen intrinsically resistant to many antibiotics, accounted for 9% of infections overall, but regional variation was wide.

Follow-up data from the same ICUs showed that active infection roughly doubled a patient’s risk of death in hospital (33.1% v 14.8%; adjusted odds ratio 1.51, 95% CI 1.36 to 1.68). Infection rates went up with increasing length of stay and were associated with severity of illness and degree of organ failure.

This global collaboration follows a similar but smaller European effort completed in 1992. If anything, infections have become more, not less, prevalent since then, says an editorial (p 2367). Gram negative bacteria now dominate the overall picture (3077/4947 (62.2%) of all positive isolates), disappointing hopes that these hard to treat infections were on the wane.

Bivalent HPV vaccine protects for at least six years

The latest follow-up data from an early trial suggest that GlaxoSmithKline’s vaccine against human papillomavirus (HPV) types 16 and 18 protects young women against infections and related cervical abnormalities for at least six years. Women in the original trials had a mean age of 20 and no evidence of current or previous HPV infections when recruited. After six years of follow-up, researchers report no persistent infections with HPV 16 …

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