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Healthcare-Associated Infections after Subarachnoid Hemorrhage.
World Neurosurg. 2018 Apr 17;:
Authors: Abulhasan YB, Alabdulraheem N, Schiller I, Rachel SP, Dendukuri N, Angle MR, Frenette C
Abstract
OBJECTIVE: Healthcare-associated infections (HAIs) after subarachnoid hemorrhage (SAH) are prevalent; however, data describing epidemiology of infection is limited. This study reports incidence rates, risk factors and the resulting SAH patient-related outcomes.
METHODS: We studied the incidence of ICU-acquired HAIs over a 6-year period. We used Bayesian Model Averaging to identify risk factors associated with an increased risk of HAIs, particularly urinary tract infections (UTI), pneumonia and ventriculostomy-associated infections (VAI). We also examined the impact of HAIs on risk of vasospasm, ICU and hospital length-of-stay, and discharge disposition, while adjusting for other risk factors.
RESULTS: Of 419 SAH patients, 66 (15.8%) developed 79 HAI episodes. Mean HAI incidence rates (per 1,000 ICU-days) were: UTI 7.1, pneumonia 4.3, and VAI 2.4. The admission characteristic associated with increased risk of overall HAI, UTI and VAI was diabetes mellitus. Hunt and Hess grades III-V were associated with increased risk of overall HAI and VAI. Male gender, intraventricular hemorrhage and blood glucose (>10) were associated with increased risk of pneumonia, while the incidence was lower in the presence of steroids. HAI was associated with increased length-of-stay of 10 ICU-days and 22 hospital-days, but not vasospasm or poor discharge disposition.
CONCLUSIONS: HAIs are serious complications after SAH associated with prolonged ICU and hospital length-of-stay. Additional rigorous infection control measures aimed at patients with identifiable risk factors should trigger prevention and early detection of nosocomial infections are warranted to further reduce the prevalence of HAIs.
PMID: 29678711 [PubMed - as supplied by publisher]
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