Document Detail


Impact of nosocomial infectious complications after subarachnoid hemorrhage.
MedLine Citation:
PMID:  18300894     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Critically ill neurological patients are susceptible to infections that may be distinct from other intensive care patients. The aim of this study is to quantify the prevalence, risk factors, and effect on the outcome of nosocomial infectious complications in patients with subarachnoid hemorrhage (SAH). METHODS: We studied 573 consecutive patients with SAH, identified the most prevalent infectious complications, and performed univariate analyses to determine risk factors for each complication. Multiple logistic regression models were constructed to calculate adjusted odds ratios for associated risk factors and to assess the impact of infectious complications on 3-month outcome as evaluated with the modified Rankin Scale. RESULTS: The most prevalent nosocomial infections were pneumonia (n = 114, 20%), urinary tract infection (n = 77, 13%), bloodstream infection (BSI) (n = 48, 8%), and meningitis/ventriculitis (n = 28, 5%). Significant independent associations with pneumonia included older age, poor Hunt and Hess grade, intubation/mechanical ventilation, and loss of consciousness at ictus. Urinary tract infection was associated with female sex and central line use. BSI was also associated with central line use, and meningitis/ventriculitis was associated with the presence of intraventricular hemorrhage and external ventricular drainage (all P < 0.05). After adjustment for Hunt and Hess grade, aneurysm size, and age, pneumonia (adjusted odds ratio, 2.04; 95% confidence interval, 1.12-3.71; P = 0.020) and BSI (adjusted odds ratio, 2.51; 95% confidence interval, 1.14-5.56; P = 0.023) independently predicted death or severe disability at 3 months. Prolonged length of stay was significantly associated with all infection types (P < 0.001). CONCLUSION: Pneumonia and BSI are common infectious complications of SAH and independently predict poor outcome. The implementation of infection-control measures may be needed to improve outcome after SAH.
Authors:
Jennifer A Frontera; Andres Fernandez; J Michael Schmidt; Jan Claassen; Katja E Wartenberg; Neeraj Badjatia; Augusto Parra; E Sander Connolly; Stephan A Mayer
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Neurosurgery     Volume:  62     ISSN:  1524-4040     ISO Abbreviation:  Neurosurgery     Publication Date:  2008 Jan 
Date Detail:
Created Date:  2008-02-27     Completed Date:  2008-04-09     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7802914     Medline TA:  Neurosurgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  80-7; discussion 87     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York 10029, USA. Jennifer.Frontera@mountsinai.org
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Communicable Diseases / classification,  complications,  epidemiology
Cross Infection / classification*,  complications*,  epidemiology*,  mortality
Disease Progression
Female
Health Surveys
Humans
Male
Middle Aged
Mortality
Odds Ratio
Regression Analysis
Retrospective Studies
Risk Factors
Subarachnoid Hemorrhage / complications*,  epidemiology*

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