TY - JOUR
T1 - Nosocomial Infections and Outcomes after Intracerebral Hemorrhage
T2 - A Population-Based Study
AU - Murthy, Santosh B.
AU - Moradiya, Yogesh
AU - Shah, Jharna
AU - Merkler, Alexander E.
AU - Mangat, Halinder S.
AU - Iadacola, Costantino
AU - Hanley, Daniel F.
AU - Kamel, Hooman
AU - Ziai, Wendy C.
N1 - Funding Information:
We would like to express our sincere thanks to Dr. Gayane Yenokyan from the Department of Biostatistics at Johns Hopkins Bloomberg School of Public Health for statistical advice. S. Murthy is supported by the American Academy of Neurology and the American Brain Foundation. C. Iadecola is supported by NIH Grants R37NS089323-02, R01 NS034179-21, R01 NS037853-19, and R01 NS073666-04. H. Kamel is supported by grant K23NS082367 from the National Institute of Neurological Disorders and Stroke and the Michael Goldberg Stroke Research Fund. D.F. Hanley received significant research support through Grant Numbers 5U01NS062851 for Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage III, and 1U01NS08082 for Minimally Invasive Surgery Plus r-tPA for Intracerebral Hemorrhage Evacuation (MISTIE) III.
Publisher Copyright:
© 2016, Springer Science+Business Media New York.
PY - 2016/10/1
Y1 - 2016/10/1
N2 - 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. 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.
AB - 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. 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.
KW - Clinical outcome
KW - Infections
KW - Intracerebral hemorrhage
KW - Meningitis
KW - Nationwide inpatient sample
KW - Pneumonia
KW - Sepsis
KW - Urinary tract infection
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U2 - 10.1007/s12028-016-0282-6
DO - 10.1007/s12028-016-0282-6
M3 - Article
C2 - 27350549
AN - SCOPUS:84976259088
SN - 1541-6933
VL - 25
SP - 178
EP - 184
JO - Neurocritical care
JF - Neurocritical care
IS - 2
ER -