ИСТИНА

Introduction Nosocomial infections may have significant impact on outcome in critically ill neurological patients. We prospectively estimate the structure of nosocomial infections in patients with severe stroke in the intensive care setting. Results We analyzed 47 cases of severe stroke (20 males, 27 females, median age 42 years) in 2013. Sixty percent had ischemic stroke and 40% of patients had intracranial hemorrhage. Nosocomial infections were identified in 55.3% patients. The most common nosology was pneumonia followed by urinary tract infections (UTI) and catheter-associated bloodstream infections (BSI), and sinusitis (96.2%, 50.0%, 50.0% and 26.9% of patients with infectious complications, respectively; see also Fig. 1). Pneumonia was ventilator-associated in 72% cases, and only 21% patients, who required respiratory support, did not have pneumonia or sinusitis. Pneumonia was associated with gram-negative pathogens with high risk of multidrug resistance (Klebsiella spp. – 24.0%, Pseudomonas aeruginosa – 8.0%). The majority of UTI was associated with Enterococcus faecalis (23.1%), Escherichia coli and Proteus mirabilis (15.4%). The most common pathogens in bloodstream infections were Staphylococcus haemolyticus (23.1%), Staphylococcus epidermidis (15.4%) and Staphylococcus hominis (15.4%), while gram-negative pathogens (Pseudomonas aeruginosa) were found in 15.4 cases. Isolated infectious complication was found in 19.1% cases while 65.4% patients had combination of at least two infections, including 8.5% patients with all 4 types of infections. Nosocomial infections were associated with increased duration of ICU stay from median 14 days in patients without infection to 27 days in patients with at least one infection, and to 113 days in 4 infections. Similar results were shown for mechanical ventilation: patients with 0 or 1 complication were ventilated for median 8 or 9 days, respectively, while patients with 2 or more infections required respiratory support for median 50 days (Fig. 2). Mortality was similar in patients without infectious complications and in patients with one or two types of nosocomial infections (14.3% vs. 22.7% and 16.7%, respectively, p >0.05), while all patients with 3 types of infection survived and among patients with 4 infections 50% died (Fig. 3). However, infectious complication was never considered as an immediate cause of death. Conclusion About half of ICU stroke patients are at risk of infectious complications that may double the length of stay and aggravate the need for mechanical ventilation. The most harmful effect has the often seen combination of several types of infections.