Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study

Santosh B. Murthy, Yogesh Moradiya, Jharna Shah, Alexander E. Merkler, Halinder S. Mangat, Costantino Iadacola, Daniel F Hanley, Hooman Kamel, Wendy C Ziai

Research output: Contribution to journalArticle

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. 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.

Original languageEnglish (US)
Pages (from-to)1-7
Number of pages7
JournalNeurocritical Care
DOIs
StateAccepted/In press - Jun 27 2016

Fingerprint

Cerebral Hemorrhage
Cross Infection
Infection
Population
Odds Ratio
Regression Analysis
International Classification of Diseases
Hospital Mortality
Urinary Tract Infections
Comorbidity
Inpatients
Length of Stay
Pneumonia
Logistic Models
Demography
Costs and Cost Analysis
Mortality

Keywords

  • Clinical outcome
  • Infections
  • Intracerebral hemorrhage
  • Meningitis
  • Nationwide inpatient sample
  • Pneumonia
  • Sepsis
  • Urinary tract infection

ASJC Scopus subject areas

  • Clinical Neurology
  • Critical Care and Intensive Care Medicine

Cite this

Murthy, S. B., Moradiya, Y., Shah, J., Merkler, A. E., Mangat, H. S., Iadacola, C., ... Ziai, W. C. (Accepted/In press). Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study. Neurocritical Care, 1-7. https://doi.org/10.1007/s12028-016-0282-6

Nosocomial Infections and Outcomes after Intracerebral Hemorrhage : A Population-Based Study. / Murthy, Santosh B.; Moradiya, Yogesh; Shah, Jharna; Merkler, Alexander E.; Mangat, Halinder S.; Iadacola, Costantino; Hanley, Daniel F; Kamel, Hooman; Ziai, Wendy C.

In: Neurocritical Care, 27.06.2016, p. 1-7.

Research output: Contribution to journalArticle

Murthy, Santosh B. ; Moradiya, Yogesh ; Shah, Jharna ; Merkler, Alexander E. ; Mangat, Halinder S. ; Iadacola, Costantino ; Hanley, Daniel F ; Kamel, Hooman ; Ziai, Wendy C. / Nosocomial Infections and Outcomes after Intracerebral Hemorrhage : A Population-Based Study. In: Neurocritical Care. 2016 ; pp. 1-7.
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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. 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.",
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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

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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.

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