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Rate and impact of multidrug-resistant organisms in patients with aneurysmal subarachnoid hemorrhage

  • Original Article - Neurosurgical intensive care
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Abstract

Background

Multidrug-resistant organisms (MDRO) are an increasing problem in critical care medicine. This study describes for the first time the rate and impact of MDRO in patients suffering from aneurysmal subarachnoid hemorrhage (SAH).

Methods

Anonymized data of SAH patients admitted to our institution from November 2010 to August 2017 were retrospectively reviewed. Patients with microbiological tests positive for MDRO were identified. Screening of MDRO was in consensus with national recommendations.

Results

449 SAH patients were reviewed with 18 patients (prevalence: four MDRO-positive patients per 100 SAH patients) having positive tests for MDRO during their hospital stay. The prevalence upon admission was 1.3 MDRO-positive patients per 100 patients. The acquisition rate was 1.1 MDRO-positive patients per 1000 hospital days. Patients positive for an MDRO had a significantly extended length of stay in intensive care (mean ± SD 26.7 ± 13.0 versus 18.4 ± 11.7 days, p = 0.004) and in hospital (mean ± SD 33.9 ± 12.4 versus 24.4 ± 12.6 days, p = 0.002). MDRO detection was associated with a significant prolonged duration of mechanical ventilation (median (IQR) 254.0 (14.9–632.8) versus 37.5 (3.3–277.0) hours, p = 0.02). There was no statistically significant effect on the Glasgow Outcome Scale (GOS) at discharge and at follow-up after 164.4 ± 113.0 days.

Conclusions

MDRO positivity is present in 4% of aneurysmal SAH patients. It seems to be associated with a prolonged length of stay and prolonged duration of mechanical ventilation. The importance of infection control standards in neurointensive care units is emphasized.

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Abbreviations

CSF:

cerebrospinal fluid

GOS:

Glasgow Outcome Scale

ICU:

intensive care unit

IQR:

interquartile range

MDR-GNB:

multidrug resistant Gram-negative bacteria

MDRO:

multidrug-resistant organisms

MRSA:

methicillin resistant S. aureus

SAH:

subarachnoid hemorrhage

SAPS II:

Simplified Acute Physiology Score II

SD:

standard deviation

USA:

United States of America

VRE:

vancomycin resistant Enterococcus spp.

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Authors and Affiliations

  1. Department of Neurosurgery, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Marius Marc-Daniel Mader, Manfred Westphal & Patrick Czorlich

  2. Department of Intensive Care, University Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany

    Jörn Grensemann & Stefan Kluge

Authors
  1. Marius Marc-Daniel Mader
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  2. Jörn Grensemann
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  3. Stefan Kluge
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  4. Manfred Westphal
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Correspondence to Marius Marc-Daniel Mader.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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This article is part of the Topical Collection on Neurosurgical intensive care

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Mader, M.MD., Grensemann, J., Kluge, S. et al. Rate and impact of multidrug-resistant organisms in patients with aneurysmal subarachnoid hemorrhage. Acta Neurochir 160, 2049–2054 (2018). https://doi.org/10.1007/s00701-018-3637-2

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  • DOI: https://doi.org/10.1007/s00701-018-3637-2

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