European surveillance of ICU-acquired infections (HELICS-ICU), 2004–2005: ICU-acquired pneumonia

Abstract number: 1732_204

Suetens C., Savey A., Palomar M., Hiesmayr M., Lepape A., Morales I., Gastmeier P., Schmit J.C., Valinteliene R., Fabry for the HELICS-ICU Data Centre J., Health Scientific Institute of Public, Brussels 

Objective: To describe the 2004–2005 results of the European surveillance of ICU-acquired pneumonia in the HELICS-ICU (HI) network (

Methods: Six patient-based networks (Austria, Belgium, France, Spain, Luxemburg and Lithuania), 2 piloting countries (Norway, Slovakia) and 1 unit-based (Germany) surveillance networks contributed data on 15,161 episodes of ICU-acquired pneumonia (PN) from 721 ICUs between Jan 2004 and Dec 2005. Since the HI protocol excludes patients with a length of stay (LOS) of <3 days in the ICU, data from Germany (no denominator data for patients staying >2 days) were excluded for the calculation of indicators, but included for the description of infections.

Table 1. Relative frequency of 10 most frequent isolated micro-organisms in ICU-acquired pneumonia, HELICS-ICU, 2004–2005

No. of ICUs4333329112185127721
No. of isolates in PN20871587607412794385975815,567
S. aureus12.8%12.0%21.9%20.4%22.4%17.5%8.6%19.6%
P. aeruginosa22.2%18.8%14.6%17.7%23.0%23.7%22.4%18.8%
Escherichia coli6.4%8.8%9.9%6.4%8.1%3.1%12.1%8.5%
Klebsiella spp.7.7%7.6%10.7%6.4%5.6%2.1%10.3%8.1%
Enterobacter spp.6.5%11.7%7.9%5.6%6.7%1.0%8.6%7.5%
Candida spp.12.5%3.3%4.8%2.3%2.5%0.0%5.2%4.8%
Haemophilus spp.2.4%5.6%3.3%6.4%5.3%14.4%3.4%4.3%
Enterococcus spp.7.4%1.6%5.0%1.6%1.0%1.0%5.2%3.6%
Streptococcus spp.3.2%2.8%2.2%3.8%5.6%9.3%0.0%3.5%
Acinetobacter spp.3.1%1.1%2.5%10.2%3.1%14.4%0.0%3.3%

Results: Of 87,353 patients staying more than 2 days in the ICU, 8.7% acquired a PN (intubator-associated 89.9%). The median incidence density varied from 3.3 PN episodes per 1000 patient-days (pd) (distribution ICUs P25 0.0; P75 7.7) in ICUs with less than 30% patients intubated, to 6.4 (P25 3.1; P75 10.4) in ICUs with 30–59% patients intubated and 9.4 (P25 4.8; P75 13.9) in ICUs with ≥60% of patients intubated. The incidence was higher in polyvalent ICUs (P50 7.6 PN/1000 patient-days) than in surgical (P50 4.4) and medical (P50 5.7) ICUs. The most frequently reported micro-organism was S. aureus (19.6%) with an average MRSA/SA percentage resistance of 38.7%. There were marked differences in the relative frequency of isolated micro-organisms between countries (table).

The diagnosis of PN was confirmed by quantitative culture (HELICS definition PN1 or PN2) in 79% in FR, 54% in ES, 32% in AT, 21% in BE, 15% in LT and 7% in LU. In the piloting countries (limited numbers), 71% was confirmed in Norway and 0% in Slovakia.

Conclusion: Although underlying differences in diagnostic practices persist, the compatibility with the HI protocol is increasing. The level 1 (unit-based) data presented here provide sufficient indicators for continuous follow-up of infection rates within the ICU and limited risk-adjusted inter-ICU comparisons with a low workload.

Session Details

Date: 31/03/2007
Time: 00:00-00:00
Session name: European Society of Clinical Microbiology and Infectious Diseases
Location: ICC, Munich, Germany
Presentation type:
Back to top