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Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit

  • Original Article - Infection
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Abstract

Background

Abrupt increase of multidrug-resistant, extensively drug-resistant, and pandrug-resistant bacteria may complicate the course, management, and costs of neurocritical patients and is associated with high morbidity and mortality rates. No data exists regarding risk factors for colonization by gram-negative pathogens in neurocritical patients. The aim of the study was to identify risk factors associated with colonization by multidrug-resistant, extensively drug-resistant, and pandrug-resistant gram-negative bacteria in neurocritical patients.

Methods

We conducted a retrospective cohort study in a neurointensive care unit over a period of 3 years. We included adult neurocritical patients admitted for more than 48 h. We analyzed several factors including both anamnestic factors and admission diagnosis.

Results

Four hundred twenty neurocritical patients were retrospectively enrolled. Seventy-three patients developed colonization by multidrug-resistant and 53 by extensively drug-resistant gram negative pathogens. Logistic regression identified intensive care unit length of stay (LOS) as the strongest predictor for both multidrug-resistant (AUC 0.877; 95% CI 0.841–0.913) and extensively drug-resistant (AUC 0.839 0.787–0.892) gram negative pathogens. In addition, external ventricular drainage and intracerebral pressure monitoring catheter were risk factors for XDR. Survival analysis revealed that MDR bacteria colonization happens earlier (log-rank test p = 0.017).

Conclusions

Optimization of healthcare strategies is required in order to reduce patients’ length of stay to prevent multi- and extensively-drug gram-negative colonizations. Indeed, an early external ventricular drainage and intracerebral pressure monitoring catheter removal is deemed necessary as soon as clinically appropriate.

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Abbreviations

CI:

Confidence interval

DM:

Diabetes mellitus

EVD:

External ventricular drainage

XDR:

Extensively drug resistant

GCS:

Glasgow Coma Scale

IMV:

Invasive mechanical ventilation

ICP:

Intracerebral pressure

ICU:

Intensive care units

IQR:

Interquartile range

LOS:

Length of stay

MDR:

Multidrug resistant

ORs:

Odds ratios

PDR:

Pandrug resistant

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Authors and Affiliations

  1. UOC Anaesthesia and Intensive Care Unit, University Hospital of Padua, via Giustiniani 2, 35128, Padua, Italy

    Marina Munari, Francesca Franzoi, Massimo Sergi, Alessandro De Cassai, Federico Geraldini, Marzia Grandis, Massimiliano Caravello, Annalisa Boscolo & Paolo Navalesi

  2. Department of Medicine-DIMED, University of Padua, Padua, Italy

    Paolo Navalesi

Authors
  1. Marina Munari
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  2. Francesca Franzoi
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  3. Massimo Sergi
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  4. Alessandro De Cassai
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  5. Federico Geraldini
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  6. Marzia Grandis
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  7. Massimiliano Caravello
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  8. Annalisa Boscolo
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  9. Paolo Navalesi
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Correspondence to Alessandro De Cassai.

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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. All persons gave their informed consent prior to their inclusion in the study.

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Munari, M., Franzoi, F., Sergi, M. et al. Extensively drug-resistant and multidrug-resistant gram-negative pathogens in the neurocritical intensive care unit. Acta Neurochir 164, 859–865 (2022). https://doi.org/10.1007/s00701-020-04611-3

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  • DOI: https://doi.org/10.1007/s00701-020-04611-3

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