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). 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. A total of 10 640 patients (70%) received at least 1 antibiotic. 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. Among the 8135 patients with suspected or proven infection, 5259 (65%) had at least 1 positive microbiological culture; 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). The in-hospital mortality rate was 30% (2404/7936) in patients with suspected or proven infection. 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). 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. 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.

Bloomsbury Institute of Intensive Care Medicine University College London London England

Critical Care Department Cliniques Universitaires St Luc UCL Brussels Belgium

Department of Anaesthesia and Critical Care SWBH Trust Birmingham England

Department of Anesthesia and Intensive Care Faculty of Medicine Universitas Indonesia Cipto Mangunkusumo Hospital Jakarta

Department of Anesthesiology and Intensive Care Medicine University Hospital of Ostrava Ostrava Czech Republic

Department of Anesthesiology and Intensive Care Uniklinikum Jena Jena Germany

Department of Anesthesiology Section on Critical Care Medicine Wake Forest University School of Medicine Wake Forest Baptist Medical Center Winston Salem North Carolina Outcomes Research Consortium Cleveland Ohio

Department of Critical Care Medicine Ghent University Hospital Ghent Belgium

Department of Critical Care Medicine University of Pittsburgh Pittsburgh Pennsylvania

Department of Intensive Care Erasme University Hospital Université Libre de Bruxelles Brussels Belgium

Department of Intensive Care Medicine Multidisciplinary Intensive Care Research Organization St James's Hospital Dublin Ireland Hospital Clinic IDIBAPS Universidad de Barcelona CIBERES Barcelona Spain

Department of Medical Microbiology University Medical Center Utrecht University Utrecht the Netherlands

Department of Surgical Science University of Turin University Hospital Città della Salute e della Scienza Turin Italy

Department of Surgical Sciences and Integrated Diagnostics University of Genoa Genoa Italy Anesthesia and Intensive Care San Martino Policlinico Hospital IRCCS for Oncology and Neuroscience Genoa Italy

Division of Pulmonary and Critical Care Medicine School of Medicine Washington University in St Louis St Louis Missouri

George Institute for Global Health University of New South Wales Sydney Australia

Intensive Care Department Universidade Federal de São Paulo São Paulo Brazil

Level l Trauma Centre Netcare Union Clinton Hospitals Alberton South Africa

Li Ka Shing Knowledge Institute St Michael's Hospital Toronto Ontario Canada

Medanta Institute of Critical Care and Anesthesiology Medanta The Medicity Gurugram India

Medical and Infectious Diseases ICU AP HP Bichat Claude Bernard University Hospital Paris France

Medical ICU Peking Union Medical College Hospital Beijing China

Unidad de Cuidados Intensivos Adultos Hospital Juárez de México Mexico City

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