Nosocomial Infections in Patients With Spontaneous Intracerebral Hemorrhage

Hinduja, Archana; Dibu, Jamil; Achi, Eugene; Patel, Anand; Samant, Rohan; Yaghi, Shadi

doi:10.4037/ajcc2015422

Cited by 31 publications

(23 citation statements)

References 21 publications

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“…The average NICU LOS was similar as previously reported in ICH patients [8 days] (9, 12). Likewise, the identified association between all types of IC and prolonged length of NICU stay is consistent with previously published data (9, 11, 12).…”

Section: Discussionsupporting

confidence: 92%

“…It is important to mention that our cohort includes all clinical and radiographic severity grades since all ICH patients presenting to our emergency room were included in the study. Pneumonia was the most common IC followed by UTI, sepsis and ventriculitis, comparable to formerly reported prevalence rates of 10–20%, 8–17%, 1–3.6%, and 0.3–3%, respectively (7, 11, 12, 20).…”

Section: Discussionsupporting

confidence: 84%

“…This hypothesis is supported by the higher occurrence rate of ventriculitis (11%) in our patients with EVD, while no other risk factors for ventriculitis could be identified (22). Moreover, infratentorial hematoma location has previously been associated with neurogenic dysphagia (23) and may also lead to IC including the development of pneumonia (11).…”

Section: Discussionmentioning

confidence: 99%

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Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome

et al. 2019

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Background: Infectious complications (IC) commonly occur in patients with intracerebral hemorrhage (ICH) and are associated with increased length of hospitalization (LOS) and poor long-term outcome. Little is known about early ICH-related predictors for the development of IC to allow appropriate allocation of resources and timely initiation of preventive measures. Methods: We prospectively enrolled 229 consecutive patients with non-traumatic ICH admitted to the neurocritical care unit (NICU) of a tertiary care hospital. Patients were screened daily for IC. Multivariable regression models using generalized linear models were used to identify associated factors with the occurrence of IC and to study their impact on functional outcome, which was assessed using the modified Rankin Scale Score (mRS) after 3 months. Unfavorable outcome was defined as mRS ≥3. Results: The most common IC were pneumonia ( n = 64, 28%) and urinary tract infection ( n = 54, 24%), followed by sepsis ( n = 9, 4%) and ventriculitis ( n = 4, 2%). Patients with a higher admission ICH Score (>2) had higher odds to develop any IC during NICU stay (OR = 1.7, 95% CI 1.2–2.3, p = 0.02). Moreover, early-onset pneumonia (≤48 h after admission) was predictive of sepsis occurring at a later time-point (median at day 11 [IQR = 6–34 days], adjOR = 22.5, 95% CI 4.88–103.6, p < 0.001). Having at least one IC and pneumonia itself were independently associated with unfavorable 3-months outcome (adjOR = 3.0, 95% CI 1.41–6.54, p = 0.005; adjOR = 4.2, 95% CI 1.33–13.19, p = 0.015, respectively). All patients with sepsis died or had poor functional outcome. Conclusions: Infectious complications are common in ICH patients and independently associated with unfavorable outcome. An ICH Score >2 on admission and early pneumonia may help to early identify patients at high risk of IC to allocate resources and start careful surveillance.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

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Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome

et al. 2019

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“…Ventriculitis/meningitis following EVD insertion is a relatively common healthcare-acquired infection in neurosurgical patients if less prevalent than respiratory tract, urinary tract and bloodstream infections. [12][13][14] A variety of recent studies reveal a variation in the proportion of patients with meningitis/ventriculitis after EVD insertion and also the actual incidence per 1,000 catheter-days. In a study from New York of 343 patients, the proportion of patients developing ventriculitis was 3.5% and 10/12 patients with positive CSF cultures also had infections elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study

Humphreys

Jenks

Wilson

et al. 2017

Journal of Hospital Infection

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Routine and ongoing monitoring of patients with an EVD in situ to detect meningitis/ventriculitis presents logistical difficulties, and few units do so. This pilot study suggests that a national system of surveillance with agreed definitions and a methodology to enable unit-to-unit comparisons of EVD meningitis/ventriculitis is both necessary and feasible. This will, in turn, inform quality improvement processes leading to the minimization of infection.

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“…E. coli as a causative microorganism was found in 14% of cultures. The same rate of meningitis/ventriculitis was found among 202 patients with spontaneous intracerebral haemorrhage [ 11 ]. Our patient suffered from subarachnoid haemorrhage with subsequent hydrocephalus and transient need for external ventricular drainage.…”

Section: Discussionmentioning

confidence: 70%

Neuroinvasive Infection from O117:K52:H-Escherichia colifollowing Acute Pyelonephritis

Cromlin

Rodríguez-Villalobos

Deplano

et al. 2017

Case Reports in Infectious Diseases

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Spontaneous or nosocomial Escherichia coli meningitis remains rare in healthy adults but is still carrying a high mortality rate despite adapted antimicrobial treatment for susceptible strains. A 39-year-old woman was admitted to the hospital with severe subarachnoid haemorrhage complicated by acute hydrocephalus. On hospital day 10, she developed Streptococcus anginosus septicaemia and urinary tract infection due to a multisensitive strain of E. coli. This infection was successfully controlled by antimicrobial therapy. As a late complication in the neurosurgical ward (day 39), she developed fever, alteration of consciousness, and shock, leading to the diagnosis of bacterial meningitis. The culture of blood, cerebrospinal fluid, and urine grew positive for a multisensitive E. coli. The strain was identified as O117:K52:H, a serotype that was until now never associated with acute meningitis or brain abscesses. The source appeared to be the urinary tract with the demonstration of acute pyelonephritis. The patient died on day 94 from delayed complications of multiple brain abscesses.

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Nosocomial Infections in Patients With Spontaneous Intracerebral Hemorrhage

Abstract: Pneumonia was the most common infection among patients with intracerebral hemorrhage.

Cited by 31 publications

References 21 publications

Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome

Early Predictors for Infectious Complications in Patients With Spontaneous Intracerebral Hemorrhage and Their Impact on Outcome

Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study

Neuroinvasive Infection from O117:K52:H-Escherichia colifollowing Acute Pyelonephritis

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