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Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence

  • Clinical Article - Infection
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Abstract

Background

Data on nosocomial bloodstream infections (NBSI) in neurosurgery is limited. This study aimed to analyze the epidemiology, microbiology, outcome, and risk factors for death in neurosurgical patients with NBSI in a multidrug resistant setting.

Methods

Neurosurgical patients with a confirmed NBSI within the period 2003–2012 were retrospectively analyzed. NBSI was diagnosed when a pathogen was isolated from a blood sample obtained after the first 48 h of hospitalization. Patients’ demographic, clinical, and microbiological data were recorded and analyzed using univariate and multivariate analysis.

Results

A total of 236 patients with NBSI were identified and 378 isolates were recovered from blood cultures. Incidence of NBSI was 4.3 infections/1000 bed-days. Gram-negative bacteria slightly predominated (54.5 %). The commonest bacteria were coagulase-negative staphylococci (CoNS, 26 %), Klebsiella pneumoniae (15.3 %), Pseudomonas aeruginosa (14.8 %), and Acinetobacter baumannii (13.2 %). Carbapenem resistance was found in 90 % of A. baumannii, in 66 % of P. aeruginosa, and in 22 % (2003–2007) to 77 % (2008–2012) of K. pneumoniae isolates (p < 0.05). Most CoNS and Staphylococcus aureus isolates (94 and 80 %, respectively) were methicillin-resistant. All Gram-negative isolates were sensitive to colistin and all Gram-positive isolates were sensitive to vancomycin and linezolid. Antimicrobial consumption decreased after 2007 (p < 0.05). Overall mortality was 50.4 %. In multivariate analysis, advanced age and stay in an Intermediate Care Unit (IMCU) were independent risk factors for in-hospital mortality (p < 0.05).

Conclusions

Overall, high incidence of NBSI and considerable resistance of Gram-positive and particularly Gram-negative bacteria were noted in neurosurgical patients. Mortality was high with advanced age and stay in IMCU being the most important death-related factors.

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Authors and Affiliations

  1. 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece

    Parmenion P. Tsitsopoulos, Dimitrios M. Anestis, Georgios Papaevangelou, Eftychios Kyriazidis & Christos Tsonidis

  2. Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece

    Elias Iosifidis, Charalampos Antachopoulos & Emmanuel Roilides

  3. 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece

    Elias Iosifidis, Charalampos Antachopoulos & Emmanuel Roilides

  4. Department of Microbiology, Hippokration General Hospital, Thessaloniki, Greece

    Ekaterini Karantani & Angeliki Karyoti

Authors
  1. Parmenion P. Tsitsopoulos
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  2. Elias Iosifidis
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  3. Charalampos Antachopoulos
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  4. Dimitrios M. Anestis
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  5. Ekaterini Karantani
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  7. Georgios Papaevangelou
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  8. Eftychios Kyriazidis
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  9. Emmanuel Roilides
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  10. Christos Tsonidis
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Corresponding author

Correspondence to Parmenion P. Tsitsopoulos.

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Acknowledgments

The authors are thankful to registered nurse Eleni Pappa for contributing to data collection for the years 2007 and 2008.

Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Comments

Tsitsopoulos and coworkers have retrospectively analyzed nosocomial bloodstream infections in neurosurgical patients over 10 years in a single-center study with high antimicrobial drug-resistance prevalence. We all have to deal with the problem of an increasing number of one or multiple drug-resistant bacterial infections. I agree with the authors that appropriate studies about this topic seem to be underrepresented for neurosurgical patients. Thus, this 10-year single-center analysis deserves being published in my opinion. The weaknesses of the present study (especially its retrospective design) are adequately discussed by the authors.

Marcus Reinges

Giessen, Germany

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Tsitsopoulos, P.P., Iosifidis, E., Antachopoulos, C. et al. Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence. Acta Neurochir 158, 1647–1654 (2016). https://doi.org/10.1007/s00701-016-2890-5

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  • DOI: https://doi.org/10.1007/s00701-016-2890-5

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