The incidence and outcomes of healthcare-associated respiratory tract infections in non-ventilated neurocritical care patients: Results of a 10-year cohort study. (March 2022)

• Record Type: Journal Article
• Authors: Ershova, Ksenia; Savin, Ivan; Khomenko, Oleg; Wong, Darren; Danilov, Gleb; Shifrin, Michael; Sokolova, Ekaterina; O'Reilly-Shah, Vikas N; Lele, Abhijit V.; Ershova, Olga
• Is Part Of: Journal of clinical neuroscience. Volume 97(2022)
• Page Start: 32
• Page End: 41
• Publication Date: 2022-03
• Subjects: ADF Augmented Dickey-Fuller test -- CDC/NHSN The Center for Disease Control / National Healthcare Safety Network -- CI Confidence interval -- CNS Central Nervous System -- ICU Intensive Care Unit -- ICU LOS Length of Stay in the ICU -- HAI Healthcare-Associated Infections -- HARTI Healthcare-Associated Respiratory Tract Infections -- LOS Length of Stay in the hospital -- NVA-HARTI Non-Ventilator-Associated Healthcare-Associated Respiratory Tract Infections -- NSI Burdenko National Medical Research Center of Neurosurgery -- ROC-AUC Receiving-Operating Curve, an Area Under the Curve -- VA-HARTI Ventilator-Associated Healthcare-Associated Respiratory Tract Infections -- VAP Ventilator-Associated Pneumonia; Cross infections -- Ventilator-associated pneumonia -- Respiratory tract infections -- Critical care outcomes -- Observational study -- Neurocritical care; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2021.12.035
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: Both VA-and NVA-HARTI are prevalent in neurosurgical critical care patients. While the VA-HARTI incidence reduced over time, NVA-HARTI incidence did not change. NVA-HARTI was associated with higher hospital and ICU LOS. VA-HARTI was an independent predictor of mortality while NVA-HARTI was not. Extrapolating VA-HARTI research findings to NVA-HARTI should be avoided. Abstract: The incidence of healthcare-associated respiratory tract infections in non-ventilated patients (NVA-HARTI) in neurosurgical intensive care units (ICUs) is unknown. The impact of NVA-HARTI on patient outcomes and differences between NVA-HARTI and ventilator-associated healthcare-associated respiratory tract infections (VA-HARTI) are poorly understood. Our objectives were to report the incidence, hospital length of stay (LOS), ICU LOS, and mortality in NVA-HARTI patients and compare these characteristics to VA-HARTI in neurocritical care patients. This cohort study was conducted in a neurosurgical ICU in Moscow. From 2011 to 2020, all patients with an ICU LOS > 48 h were included. A competing risk model was used for survival and risk analysis. A total of 3, 937 ICU admissions were analyzed. NVA-HARTI vs VA-HARTI results were as follows: cumulative incidence 7.2 (95%CI: 6.4–8.0) vs 15.4 (95%CI: 14.2–16.5) per 100 ICU admissions; incidence rate 4.2 ± 2.0 vs 9.5 ± 3.0 per 1000 patient-days in the ICU; median LOS 32 [Q1Q3: 21, 48.5] vs 46 [Q1Q3: 28, 76.5] days; median ICU LOS 15 [Q1Q3: 10, 28.75] vs 26 [Q1Q3: 17, 43] days; mortality 12.3% (95%CI: 7.9–16.8) vs 16.7% (95%CI: 13.6–19.7). The incidence of VA-HARTI decreased over ten years while NVA-HARTI incidence did not change. VA-HARTI was an independent risk factor of death, OR 1.54 (1.11–2.14), while NVA-HARTI was not. Our findings suggest that NVA-HARTI in neurocritical care patients represents a significant healthcare burden with relatively high incidence and associated poor outcomes. Unlike VA-HARTI, the incidence of NVA-HARTI remained constant despite preventive measures. This suggests that extrapolating VA-HARTI research findings to NVA-HARTI should be avoided.