Abstract
Patient care in a neurointensive care unit (neuro-ICU) is challenging. Multidrug-resistant organisms (MDROs) are increasingly common in the routine clinical practice. We evaluated the impact of infection with MDROs on outcomes in patients with subarachnoid hemorrhage (SAH). A single-center retrospective analysis of SAH cases involving patients treated in the neuro-ICU was performed. The outcome was assessed 6 months after SAH using the modified Rankin Scale [mRS, favorable (0–2) and unfavorable (3–6)]. Data were compared by matched-pair analysis. Patient characteristics were well matched in the MDRO (n = 61) and control (n = 61) groups. In this center, one nurse was assigned to a two-bed room. If a MDRO was detected, the patient was isolated, and the nurse was assigned to the patient infected with the MDRO. In the MDRO group, 29 patients (48%) had a favorable outcome, while 25 patients (41%) in the control group had a favorable outcome; the difference was not significant (p > 0.05). Independent prognostic factors for unfavorable outcomes were worse status at admission (OR = 3.1), concomitant intracerebral hematoma (ICH) (OR = 3.7), and delayed cerebral ischemia (DCI) (OR = 6.8). Infection with MRDOs did not have a negative impact on the outcome in SAH patients. Slightly better outcomes were observed in SAH patients infected with MDROs, suggesting the benefit of individual care.
Highlights
Abbreviations AST Antibiotic sensitivity testing computed tomography (CT) Computer tomography cerebral vasospasm (CVS) Cerebral vasospasm delayed cerebral ischemia (DCI) Delayed cerebral ischemia ESBL Extended-spectrum β-lactamase invasive blood pressure (IBP) Invasive blood pressure intracerebral hematoma (ICH) Intracerebral hemorrhage ICU Intensive care unit length of stay (LOS) Length of stay MDR Multidrug-resistant MDS Multidrug-sensitive MDRGN Multidrug-resistant gram negative rods multidrug-resistant organisms (MDROs) Multidrug-resistant organism modified Rankin Scale (mRS) Modified Rankin Scale MRSA Methicillin-resistant staphylococcus aureus subarachnoid hemorrhage (SAH) Subarachnoid hemorrhage VRE Vancomycin-resistant enterococci World Federation of Neurosurgical Societies scale (WFNS) World Federation of Neurological Surgeons
0–2 favorable 3–6 unfavorable like admission status according to the World Federation of Neurosurgical Societies scale (WFNS), the development of delayed cerebral ischemia (DCI), cerebral vasospasm (CVS), location of the aneurysmal bleeding, the presence of intracerebral hematoma (ICH), and the occurrence of an inflammatory reaction were identified as independent predictors for functional outcome in patients with SAH2–5
MDROs were identified in 4.9% of patients with SAH, which is comparable to other German and French data[17,18]
Summary
Abbreviations AST Antibiotic sensitivity testing CT Computer tomography CVS Cerebral vasospasm DCI Delayed cerebral ischemia ESBL Extended-spectrum β-lactamase IBP Invasive (intra-arterial) blood pressure ICH Intracerebral hemorrhage ICU Intensive care unit LOS Length of stay MDR Multidrug-resistant MDS Multidrug-sensitive MDRGN Multidrug-resistant gram negative rods MDRO Multidrug-resistant organism mRS Modified Rankin Scale MRSA Methicillin-resistant staphylococcus aureus SAH Subarachnoid hemorrhage VRE Vancomycin-resistant enterococci WFNS World Federation of Neurological Surgeons. Subarachnoid hemorrhage (SAH) is a severe brain injury associated with high morbidity and mortality. It requires immediate hospital admission following endovascular or microsurgical treatment[1]. Infections, with multidrug-resistant organisms (MDROs), are serious complications associated with extended hospital stays, increased costs and are considered predictive of a worse outcome[11,12,13,14]. We assessed the impact of nosocomial infection with MDROs and subsequent isolation on the outcome in SAH patients in this study
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