Nosocomial bloodstream infections in neurosurgical patients. A5year study
Abstract number: P1192
Tsitsopoulos P., Iosifidis E., Antachopoulos C., Anagnostopoulos I., Tsivitanidou M., Roilides E., Tsitsopoulos P.
Objectives: Nosocomial infections are a common, serious problem in neurosurgical patients. Nosocomial blood stream infections (NBSI) are associated with increased morbidity and mortality. We analyzed NBSI in neurosurgical patients in a single centre over a five-year period.
Methods: A retrospective study was conducted in a 24-bed neurosurgical department between 20022006. Medical records and postoperative courses of 3318 patients involved in 1772 neurosurgical procedures were reviewed to determine the prevalence and characteristics of NBSI, the identity of isolated organisms, and the antimicrobial drug resistance of selected pathogens. Chi-square test was used for statistical analysis.
Results: Overall NBSI frequency was 3% (102/3318 patients) [24/1546 (1.5%) in non-operated patients and 78/1772 (4.4%) in operated patients (p < 0.0001)]. The median age of patients was 52.4 years (range 1785) and the median length of stay was 39.4 days (range 5195). The primary diagnosis was head trauma in 39% of cases followed by intracerebral haemorrhage (22%) and brain tumour (17%). Neurosurgical procedures were elective in 1144 and emergency in 628 patients. Central venous catheter was present in 63 of 102 patients with NBSI (61.7%). The most frequently isolated organism was Klebsiella pneumoniae (KP, 32 isolates; 22.2%) followed by Pseudomonas aeruginosa (PA, 24 isolates; 16.9%), Acinetobacter baumannii (AB, 15 isolates; 10.5%), Enterococcus faecium (EF, 15 isolates; 10.5%) and Staphylococcus aureus (SA, 14 isolates; 9.8%). Resistance rates of KP and PA were 94 and 67% to ceftazidime, 56 and 71% to piperacillin/tazobactam, 17 and 63% to imipenem, 84 and 92% to gentamicin, 50 and 83% to ciprofloxacin, respectively. All AB isolates were resistant to ceftazidime and ciprofloxacin, whereas 66.6% were resistant to imipenem and 53% to gentamicin. There was no vancomycin-resistant EF, but 64.2% of SA were methicillin-resistant. In patients with NBSI mortality rate was 49% (50/102), in contrast to 5.4% (175/3216) found in those without NBSI (p < 0.0001).
Conclusion: NBSI constitute a serious problem in neurosurgical patients, especially postoperatively, with high frequency and mortality. The predominant organisms in our institution are multidrug-resistant Gram-negative bacteria. Understanding the patterns of neurosurgical NBSI may help to optimise infection control interventions as well as antimicrobial use.
|Session name:||19th European Congress of Clinical Microbiology and Infectious Diseases|
|Location:||Helsinki, Finland, 16 - 19 May 2009|
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