Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study
- PDF / 459,234 Bytes
- 7 Pages / 595.276 x 790.866 pts Page_size
- 14 Downloads / 169 Views
ORIGINAL ARTICLE
Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study Santosh B. Murthy1,2 • Yogesh Moradiya3 • Jharna Shah4 • Alexander E. Merkler1 • Halinder S. Mangat1 • Costantino Iadacola1,2 • Daniel F. Hanley5 • Hooman Kamel1,2 Wendy C. Ziai4
•
Ó Springer Science+Business Media New York 2016
Abstract Background Infections after intracerebral hemorrhage (ICH) may be associated with worse outcomes. We aimed to evaluate the association between nosocomial infections (>48 h) and outcomes of ICH at a population level. Methods We identified patients with ICH using ICD-9-CM codes in the 2002–2011 Nationwide Inpatient Sample. Demographics, comorbidities, surgical procedures, and hospital characteristics were compared between patients with and without concomitant nosocomial infections. Primary outcomes were in-hospital mortality and home discharge. Secondary outcome was permanent cerebrospinal shunt placement. Logistic regression analyses were used to analyze the association between infections and outcomes.
Electronic supplementary material The online version of this article (doi:10.1007/s12028-016-0282-6) contains supplementary material, which is available to authorized users. & Santosh B. Murthy [email protected] 1
Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY 10065, USA
2
Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA
3
Department of Neurosurgery, Northwell Long Island Jewish School of Medicine, New York, NY, USA
4
Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA
5
Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA
Results Among 509,516 ICH patients, infections occurred in 117,636 (23.1 %). Rates of infections gradually increased from 18.7 % in 2002–2003 to 24.1 % in 2010–2011. Pneumonia was the most common nosocomial infection (15.4 %) followed by urinary tract infection (UTI) (7.9 %). Patients with infections were older (p < 0.001), predominantly female (56.9 % vs. 47.9 %, p < 0.001), and more often black (15.0 % vs. 13.4 %, p < 0.001). Nosocomial infection was associated with longer hospital stay (11 vs. 5 days, p < 0.001) and a more than twofold higher cost of care (p < 0.001). In the adjusted regression analysis, patients with infection had higher odds of mortality [odds ratio (OR) 2.11, 95 % CI 2.08–2.14] and cerebrospinal shunt placement (OR 2.19, 95 % CI 2.06–2.33) and lower odds of home discharge (OR 0.49, 95 % CI 0.47–0.51). Similar results were observed in subgroup analyses of individual infections. Conclusions In a nationally representative cohort of ICH patients, nosocomial infection was associated with worse outcomes and greater resource utilization. Keywords Intracerebral hemorrhage Infections Pneumonia Sepsis Meningitis Urinary tract infection Clinical outco
Data Loading...
