Abstract
BackgroundNosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. The primary aim of this study was to determine incidence of nosocomial infections and multidrug-resistant bacteria and seek predictors of nosocomial infections in a preventive multimodal nosocomial infection protocol in the neurointensive care unit (NICU). The secondary aim focused on their impact on stay, mortality and cost in the NICU.MethodsA10-year, single-centre prospective observational cohort study was conducted on 3464 acute brain disease patients. There were 198 (5.7%) patients with nosocomial infection (wound 2.1%, respiratory 1.8%, urinary 1.0%, bloodstream 0.7% and other 0.1%); 67 (1.9%) with Extended spectrum beta-lactamase (ESBL); 52 (1.5%) with Methicillin-resistant Staphylococcus aureus (MRSA), nobody with Vancomycin-resistant enterococcus (VRE). The protocol included hygienic, epidemiological status and antibiotic policy. Univariate and multivarite logistic regression analysis was used for identifying predictors of nosocomial infection.ResultsFrom 198 NI patients, 153 had onset of NI during their NICU stay (4.4%; wound 1.0%, respiratory 1.7%, urinary 0.9%, bloodstream 0.6%, other 0.1%); ESBL in 31 (0.9%) patients, MRSA in 30 (0.9%) patients. Antibiotics in prophylaxis was given to 63.0% patients (59.2 % for operations), in therapy to 9.7% patients. Predictors of NI in multivariate logistic regression analysis were airways (OR 2.69, 95% CI 1.81-3.99, p<0.001), urine catheters (OR 2.77, 95% CI 1.00-7.70, p=0.050), NICU stay (OR 1.14, 95% CI 1.12-1.16, p<0.001), transfusions (OR 1.79, 95% CI 1.07-2.97, p=0.025) antibiotic prophylaxis (OR 0.50, 95% CI 0.34-0.74, p<0.001), wound complications (OR 2.30, 95% CI 1.33-3.97, p=0.003). NI patients had longer stay (p<0.001), higher mortality (p<0.001) and higher TISS sums (p<0.001) in the NICU.ConclusionsThe presented preventive multimodal nosocomial infection control management was efficient; it gave low rates of nosocomial infections (4.2%) and multidrug-resistant bacteria (ESBL 0.9%, MRSA 0.9% and no VRE). Strong predictors for onset of nosocomial infection were accesses such as airways and urine catheters, NICU stay, antibiotic prophylaxis, wound complications and transfusion. This study confirmed nosocomial infection is associated with worse outcome, higher cost and longer NICU stay.
Highlights
Nosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients
We prospectively examined the following determined demographic and clinical parameters in our local neurointensive care unit (NICU): brain diagnosis, type of admission, admission and overall Therapeutic Intervention Scoring System (TISS), admission Glasgow Coma Scale (GCS), admission Acute Physiology and Chronic Health Evaluation (APACHE) II score, length of stay in the NICU, mortality in the NICU, Glasgow Outcome Scale (GOS) upon discharge from the NICU, C-reactive protein (CRP), operations, American Society of Anesthesiologists (ASA) Score, drainage, airways, mechanical ventilation, catheters and tubes, administration of corticoids, transfusions, ulcer prophylaxis and diabetes mellitus
Our results showed that strong predictors on onset of NI in our neurocritical care were accesses such as airways and urine catheters, NICU stay, antibiotic prophylaxis, wound complications and transfusion
Summary
Nosocomial infection (NI) control is an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients. Nosocomial infections (NI) are still an important issue in neurocritical care due to secondary brain damage and the increased morbidity and mortality of primary acute neurocritical care patients [1,2,3,4,5]. NI is associated with higher antibiotic consumption, thereby worsening the epidemiological situation in the intensive care unit by increasing the occurrence of multidrug-resistant bacteria [6] For these reasons, they have a significant economic impact because they prolong stay [7,8,9,10] in the neurointensive care unit (NICU) and the higher frequency of diagnostic and therapeutic processing significantly raises healthcare costs. The secondary aim focused on their impact on stay, mortality and cost in the NICU
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