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

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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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Acknowledgments

We would like to express our sincere thanks to Dr. Gayane Yenokyan from the Department of Biostatistics at Johns Hopkins Bloomberg School of Public Health for statistical advice. S. Murthy is supported by the American Academy of Neurology and the American Brain Foundation. C. Iadecola is supported by NIH Grants R37NS089323-02, R01 NS034179-21, R01 NS037853-19, and R01 NS073666-04. H. Kamel is supported by grant K23NS082367 from the National Institute of Neurological Disorders and Stroke and the Michael Goldberg Stroke Research Fund. D.F. Hanley received significant research support through Grant Numbers 5U01NS062851 for Clot Lysis Evaluation of Accelerated Resolution of Intraventricular Hemorrhage III, and 1U01NS08082 for Minimally Invasive Surgery Plus r-tPA for Intracerebral Hemorrhage Evacuation (MISTIE) III.

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Authors and Affiliations

  1. Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA

    Santosh B. Murthy, Alexander E. Merkler, Halinder S. Mangat, Costantino Iadacola & Hooman Kamel

  2. Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA

    Santosh B. Murthy, Costantino Iadacola & Hooman Kamel

  3. Department of Neurosurgery, Northwell Long Island Jewish School of Medicine, New York, NY, USA

    Yogesh Moradiya

  4. Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jharna Shah & Wendy C. Ziai

  5. Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Daniel F. Hanley

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  1. Santosh B. Murthy
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  2. Yogesh Moradiya
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Correspondence to Santosh B. Murthy.

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Murthy, S.B., Moradiya, Y., Shah, J. et al. Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study. Neurocrit Care 25, 178–184 (2016). https://doi.org/10.1007/s12028-016-0282-6

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