ИСТИНА

Nosocomial Infections in Stroke Patients in the Neurocritical Care Setting Background/Objectives: We aimed to study local profile of nosocomial infections and its influence on stroke outcome. Design: Data was collected in a prospective observational study in stroke patients admitted to Neurocritical Care Unit. Results: 29 subjects were included (62% males, median age 53.5), 69% had ischemic stroke, 31% - ICH; median baseline NIHSS 15.5; 75% required mechanical ventilation. Nosocomial infections were identified in 86% patients and included pneumonia, urinary tract infections (UTI), catheter-associated bloodstream infections (BSI), and sinusitis (79%, 48%, 45% and 28%, respectively). Up to 90% of ischemic stroke patients had pneumonia, (ventilator-associated pneumonia - 56%). Age >55 years and baseline NIHSS>15 predicted infection. At least two infections was found in 38% patients. Median time for pneumonia development was 6 days from admission, and 14 and 24 days for UTI and BSI, respectively. Nosocomial infections were associated with increased duration of ICU stay (median 42.5 in at least 1 infection vs 14.0 days without infection) and mechanical ventilation (median 58.5 days vs 6.5 days, respectively). Mortality was similar for no or 1, or 2 types of infections (9%, 11%, and 14%, respectively, p>0.05), while all patients with 3 types of infection survived and 40% of patients with 4 infections died. However, infectious complication was never considered as an immediate cause of death. Conclusion: ICU stroke patients are at high risk of infectious complications that may dramatically increase length of stay and mechanical ventilation. Combination of several types of infections is the most harmful and may increase mortality.