The incidence and outcomes of healthcare-associated respiratory tract infections in non-ventilated neurocritical care patients: Results of a 10-year cohort study

Ksenia Ershova; Ivan Savin; Oleg Khomenko; Darren Wong; Gleb Danilov; Michael Shifrin; Ekaterina Sokolova; Vikas N O'Reilly-Shah; Abhijit V Lele; Olga Ershova

doi:10.1016/j.jocn.2021.12.035

The incidence and outcomes of healthcare-associated respiratory tract infections in non-ventilated neurocritical care patients: Results of a 10-year cohort study

J Clin Neurosci. 2022 Mar:97:32-41. doi: 10.1016/j.jocn.2021.12.035. Epub 2022 Jan 13.

Authors

Affiliations

¹ Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Pacific Street, Box 356540, Seattle, WA 98195, USA. Electronic address: kseniae@uw.edu.
² Burdenko National Medical Research Center of Neurosurgery, 4-Ya Tverskaya-Yamskaya Ulitsa, 16, Moscow 125047, Russia.
³ Department of Computer Science, Skolkovo Institute of Science and Technology, Bolshoy Bulvar, 30, Moscow Oblast, 143026, Russia.
⁴ Division of Infectious Diseases, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
⁵ Department of Anesthesiology and Pain Medicine, University of Washington, 1959 Pacific Street, Box 356540, Seattle, WA 98195, USA.

PMID: 35033779
DOI: 10.1016/j.jocn.2021.12.035

Abstract

The incidence of healthcare-associated respiratory tract infections in non-ventilated patients (NVA-HARTI) in neurosurgical intensive care units (ICUs) is unknown. The impact of NVA-HARTI on patient outcomes and differences between NVA-HARTI and ventilator-associated healthcare-associated respiratory tract infections (VA-HARTI) are poorly understood. Our objectives were to report the incidence, hospital length of stay (LOS), ICU LOS, and mortality in NVA-HARTI patients and compare these characteristics to VA-HARTI in neurocritical care patients. This cohort study was conducted in a neurosurgical ICU in Moscow. From 2011 to 2020, all patients with an ICU LOS > 48 h were included. A competing risk model was used for survival and risk analysis. A total of 3,937 ICU admissions were analyzed. NVA-HARTI vs VA-HARTI results were as follows: cumulative incidence 7.2 (95%CI: 6.4-8.0) vs 15.4 (95%CI: 14.2-16.5) per 100 ICU admissions; incidence rate 4.2 ± 2.0 vs 9.5 ± 3.0 per 1000 patient-days in the ICU; median LOS 32 [Q1Q3: 21, 48.5] vs 46 [Q1Q3: 28, 76.5] days; median ICU LOS 15 [Q1Q3: 10, 28.75] vs 26 [Q1Q3: 17, 43] days; mortality 12.3% (95%CI: 7.9-16.8) vs 16.7% (95%CI: 13.6-19.7). The incidence of VA-HARTI decreased over ten years while NVA-HARTI incidence did not change. VA-HARTI was an independent risk factor of death, OR 1.54 (1.11-2.14), while NVA-HARTI was not. Our findings suggest that NVA-HARTI in neurocritical care patients represents a significant healthcare burden with relatively high incidence and associated poor outcomes. Unlike VA-HARTI, the incidence of NVA-HARTI remained constant despite preventive measures. This suggests that extrapolating VA-HARTI research findings to NVA-HARTI should be avoided.

Keywords: Critical care outcomes; Cross infections; Neurocritical care; Observational study; Respiratory tract infections; Ventilator-associated pneumonia.

MeSH terms

Cohort Studies
Cross Infection* / epidemiology
Cross Infection* / therapy
Delivery of Health Care
Hospital Mortality
Humans
Incidence
Intensive Care Units
Length of Stay
Respiratory Tract Infections* / epidemiology
Respiratory Tract Infections* / therapy