Early and late onset nosocomial infections in ICU patients with head injury

Introduction

The aim of this clinical study was to evaluate the incidence of nosocomial infection (NI) in ICU patients with head injury (HI) and to analyse the main characteristics of these infections.

Methods

We studied retrospectively 58 ICU patients with HI (48 men, 10 women) who developed NI. Mean age: 41.4 ± 13.8 years. Mean stay: 31.2 ± 18.4 days. These patients developed 74 episodes of NI diagnosed according to CDC criteria. Early-onset (EO) NI occurred within the first 96 hours of the ICU stay (14 episodes) and late-onset (LO) NI occurred later than 96 hours from admission (60 episodes). Mean APACHE II score at admission: 15.1 ± 10.2. All were mechanically ventilated.

Results

We diagnosed the following NI: 46 pneumonias (11 EO and 35 LO), 22 central venous catheter-related infections (CVC-RI) (all LO), one urinary tract infection (LO) and five central nervous system infections (CNSI) (three EO and two LO). The main pathogens were: P. aeruginosa 38%, A. baumannii 31%, MRSA 18%, K. pneumoniae 9%, MSSA 4%. In 10 episodes of NI (13.5%) two microbes were isolated. There was no difference between pathogens isolated in EO and LO pneumonias. Mortality rates (MR): 18/58 = 31%.

Conclusion

The most frequent NI in ICU patients with HI was pneumonia (62.2%). We noticed an important increase in CVC-RI (29.7%) especially during the last 2 years; all were LO NI with good prognosis. The most common pathogens were P. aeruginosa, A. baumannii and MRSA (totally 87%); during the last years the incidence of MRSA-NI increased significantly. A. baumannii was isolated especially in younger patients and almost never in the elderly. Pneumonias (P < 0.05) and CNSI (P < 0.05) increased MR, while no difference was seen between EO and LO pneumonias.