Predisposing factors and impact of healthcare-associated infections in patients with status epilepticus

ABSTRACT

Background: Few studies have evaluated the incidence, predisposing factors and impact of healthcare-associated infections (HCAIs) in relation to outcomes among patients with status epilepticus (SE). Objective: To investigate the variables associated with development of HCAIs among patients with SE and the impact of factors relating to HCAIs on mortality at three months. Methods: This study was a retrospective analysis on our prospectively collected dataset, from November 2015 to January 2019. The sample included all consecutive patients diagnosed with SE who were treated at Hospital Eugenio Espejo during that period. In total, 74 patients were included. Clinical variables such as age, etiology of SE, Charlson comorbidity index (CCI), hospital length of stay, refractory SE (RSE) and outcomes were analyzed. Results: HCAIs were diagnosed in 38 patients (51.4%), with a preponderance of respiratory tract infection (19; 25.7%). Prolonged hospital length of stay (OR=1.09; 95%CI 1.03-1.15) and CCI≥2 (OR=5.50; 95%CI 1.37-22.10) were shown to be independent variables relating to HCAIs. HCAIs were associated with an increased risk of mortality at three months, according to Cox regression analysis (OR=2.23; 95%CI 1.08-4.58), and with infection caused by Gram-negative microorganisms (OR=3.17; 95%CI 1.20-8.39). Kaplan-Meier curve analysis demonstrated that HCAIs had a negative impact on the survival rate at three months (log rank=0.025). Conclusions: HCAIs are a common complication among Ecuadorian patients with SE and were related to a lower survival rate at three months. Prolonged hospital length of stay, RSE and CCI≥2 were associated with the risk of developing HCAIs.

RESUMEN

Antecedentes: Pocos estudios han evaluado la incidencia, los factores predisponentes y el impacto de las infecciones asociadas a los cuidados de salud (IACS) en pacientes con Estatus Epiléptico (EE). Objetivo: Evaluar los factores predisponentes de IACS en pacientes con EE y su impacto evolutivo después de tres meses. Métodos: Se realizó un análisis retrospectivo de los datos recogidos prospectivamente en nuestra base de datos, desde noviembre de 2015 hasta enero de 2019. Se incluyeron todos los pacientes diagnosticados y consecutivamente tratados con EE, en el Hospital Eugenio Espejo, durante ese periodo. En total, 74 pacientes fueron incluidos. Se analizaron variables clínicas y evolutivas. Resultados: Las IACS fueron identificadas en 38 pacientes (51,4%), con predominio de infecciones respiratorias (25,7%). Los factores asociados con el desarrollo IACS fueron la estadía hospitalaria prolongada (OR=1,09, IC95% 1,03-1,15) y el índice de Charlson (ICH)≥2 (OR=5,50, IC95% 1,37-22,10). La regresión de Cox demostró un incremento significativo de la mortalidad en los pacientes con IACS (OR=2,23, IC95% 1,08-4,58) y en las causadas por gérmenes gram-negativos (OR=3,17, IC95% 1,20-8,39). La curva de Kaplan Meier evidenció el impacto desfavorable de las IACS (log rank=0.025) en la evolución de los pacientes después de los tres meses. Conclusiones: Las IACS fueron complicaciones frecuentes en los pacientes ecuatorianos con EE y fueron asociadas con una menor supervivencia después de los tres meses. Las variables como la estadía hospitalaria prolongada, el EE refractario y el ICH≥2 fueron identificados como factores de riesgo para sufrir una IACS.

Keywords:

Status Epilepticus - Cross Infection - Mortality - Epilepsy

Palabras clave:

Estado Epiléptico - Infección Hospitalaria - Mortalidad - Epilepsia

Authors’ contribution:

DRR: designed the study, collected and processed the data, performed the statistical analyses, performed the analysis on the results and drafted the manuscript. CSM: participated in treatment of the patients, collected the data and reviewed the final manuscript. DDS: participated in treatment of the patients and drafted the final manuscript. SGP: revised the manuscript for scientific content. YP: performed the statistical analysis. GP: revised the final manuscript.

Support:

This research did not receive any specific grant from funding agencies in the public, commercial or not-for-profit sectors.

Publikationsverlauf

Eingereicht: 06. Oktober 2019

Angenommen: 22. Juli 2020

Artikel online veröffentlicht:
07. Juni 2023

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