—We agree with Dr Langer and colleagues that prevalence studies have their limitations and that the EPIC study may have overestimated the magnitude of ICU-acquired infections. Unfortunately, we did not have access to the data sources cited by Langer et al. They refer to one study reported in abstract form for a local meeting held 10 years ago (their reference 2) and a second study for which preliminary results were published only recently (their reference 3). They also focused on the incidence of sepsis without specific presentation of the relevant data on nosocomial infections. Nevertheless, the methods used in the EPIC study were identical for the various countries, so any comparisons between or among countries remain appropriate. As we discussed in our article, the differences observed among the European countries may well be explained by different severities of illness of the patients included, as reflected by higher Acute
Vincent J, Bihari DJ, White J, Suter PM. Nosocomial Infections in Intensive Care Units-Reply. JAMA. 1996;275(5):362. doi:10.1001/jama.1996.03530290032032
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