ИСТИНА

Introduction Nosocomial infections is a common problem that may have significant impact on outcome in critically ill neurological patients. More institution-specific data on infectious complications is needed to elaborate optimal strategy of antibiotic use. Materials and Methods We assessed infectious complications in patients admitted to neurocriticalcare unit with severe vascular and neuromuscular disorders (n=67, 30 males, 37 females, median age 41 year). Results The population consisted of patients with Guillain-Barre syndrome (GBS; 49%), stroke (43%), and myasthenia gravis (8%). Infectious complications were identified in 53% cases, the most common nosology was pneumonia followed by urinary tract infections (UTI) and catheter-associated bloodstream infections (BSI), and sinusitis (96%, 50%, 50% and 27% of patients with infectious complications, see also Fig. 1). Patients with stroke were most susceptible to nosocomial infections (e.g., 100% patients with ischemic stroke had pneumonia), while in GBSpatients the rate of all types of infections was the lowest. In 65% cases patients had concurrent infections, that increased the length of ICU stay from median 10 days in patients without infection to 30 days in patients with at least one infection and duration of ventilation from 8 days in to 50 days, respectively (Fig. 2). Mortality rate did not differ in patients with no or one or two types of infections (14% vs. 22% and 18%, respectively, p>0.05), while all patients with 3 types of infection survived and among patients with 4 infections 50% died. However, infectious complication was never considered as an immediate cause of death. 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 (Klebsiellaspp.–24%, Pseudomonas aeruginosa–8%). The majority of UTI was associated with Enterococcus faecalis(23%), Escherichia coliand Proteus mirabilis(15%).The most common pathogens in bloodstream infections were Staphylococcus haemolyticus(23%), Staphylococcus epidermidis(15%) and Staphylococcus hominis(15%), while gram-negative pathogens (Pseudomonasaeruginosa)were found in 15% cases. Multidrug resistant pathogens were isolated in up to 25% cases. Conclusion A significant proportion of neuroICUpatients may have infectious complications, that is associated with increase of duration of ICU stay and need for mechanical ventilation, especially when 2 or more types of infection is present.