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Neurocritical Care
Published in: Neurocritical Care 2/2016

01-10-2016 | Original Article

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

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

Published in: Neurocritical Care | Issue 2/2016

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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.
Appendix
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Metadata
Title
Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study
Authors
Santosh B. Murthy
Yogesh Moradiya
Jharna Shah
Alexander E. Merkler
Halinder S. Mangat
Costantino Iadacola
Daniel F. Hanley
Hooman Kamel
Wendy C. Ziai
Publication date
01-10-2016
Publisher
Springer US
Published in
Neurocritical Care / Issue 2/2016
Print ISSN: 1541-6933
Electronic ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-016-0282-6

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