Saturday, December 5, 2009

Justifying my existence

As somebody training in both critical care and infectious diseases, I'm often left trying to explain what I hope to do with my career, struggling with coherent answers to both laypeople and other doctors. People get sick because of infections. Also, sick people end up getting infections. That's how I look at it, and hence my training.

This study, published by some of my bosses, helps validate all of this. Looking at one day in ICUs across the planet, they captured a point-in-time, just to see what the burden of 'infection' is in our planet's ICUs. Obviously, there are huge problems with potential reporting bias and the like, but it's as good a global survey as you can justifiably get. And the results are interesting, showing that half of all patients in ICUs were considered infected, with these patients doing significantly worse overall. Nearly three quarters of the patients were receiving antibiotics, some just for propylaxis. Also, the longer that you were sick, the more likely you were to have an infection. There was also a correlation between national GDP and rates of ICU infection, which, once again, isn't surprising, since we know that infection control procedures aren't always cheap

The types of bacteria and infections reported were interesting, with pneumonias as the most common infection, and a reasonable distribution of types of bacteria. There is an increasing prevalence of dangerous gram-negative bacteria, and a persistently worrisome rate of antibiotic-resistant bacteria. I've talked about this quandary before, since as we're able to care for sicker and sicker patients, we're also using more and more antibiotics, leading to all sorts of resistance problems for future generations. Also, what constitutes an 'infection' is a difficult distinction, one that we typically err on the side of caution by treating. In the end, with very few new antibiotics coming down the research pipeline, we will face a tremendous challenge outwitting these ever-shifting, diverse group of organisms.

Vincent JL, Rello J, Marshall J, Silva E, Anzueto A, Martin CD, Moreno R, Lipman J, Gomersall C, Sakr Y, Reinhart K, & EPIC II Group of Investigators (2009). International study of the prevalence and outcomes of infection in intensive care units. JAMA : the journal of the American Medical Association, 302 (21), 2323-9 PMID: 19952319

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