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 journalArticlepeer-review

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)178-184
Number of pages7
JournalNeurocritical care
Volume25
Issue number2
DOIs
StatePublished - Oct 1 2016

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

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