A0016 Infection in Neurosurgical Intensive Care Unit: A 3-Year Study

Background: In the neurosurgical and neurocritical patient community, infection rate depends on the severity of illness at the time of presentation such as Glasgow coma score, associated comorbidities, and the exposure to invasive devices such as endotracheal tube, central venous catheters, and urinary catheters. In addition, neuroscience-specific devices, such as ventricular/lumbar catheters, also increase chances of infection. There is paucity of quality data about infection rate in neurosurgical ICU (NSICU) in India. We share our experience from a dedicated NSICU in north India.

Materials and Methods: This was a retrospective and observational study in NSICU. All patients who were admitted to NSICU, whose infection fulfilled the CDC (Centers for Disease Control and Prevention)/National Healthcare Safety Network (NHSN) criteria, were included in the study.

Results: A total of 229 patients were included in our study. Maximum percentage of patients admitted directly from home was 41.2%. Length of stay (LOS) in the ICU ranged from 2 to 60 days. Average LOS in ICU was 6 days. A comprehensive of 57 laboratory-confirmed infections were identified in 53 patients, representing a prevalence rate of 23% and an incidence rate of 20.3/1,000 patient-days. The site-specific frequency of infections was: 35 urinary tract infections, 15 bloodstream infections, 2 SSI, single case of pneumonia. Various risk factors associated with development of HAIs were antibiotics use before ICU admission (p < 0.001, OR= 6.775), presence of devices such as endotracheal tube (p < 0.001, OR = 7.450), urinary catheter (p = 0.002, OR = 2.386), central line (p < 0.001, OR = 8.022), location before admission (p = 0.038, OR = 2.063), ICU stay > 7 days (p = 0.003, OR = 2.724), and malignancy (p = 0.001, OR = 8.775).

Conclusions: Neurosurgical patients are particularly vulnerable to infection because of the formidable nature of their illness, the frequency of associated trauma, and the presence of invasive devices. This could be the reason for high prevalence rate of infection in these patients, which can be avoided by treating the patients in a dedicated NSICU with strict infection control protocol. Nonetheless, in our study we observed low infection rate in neurosurgical patients.