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69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC)
Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

03.06. - 06.06.2018, Münster

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Epidemiology and impact of multidrug-resistant organisms in patients with aneurysmal subarachnoid hemorrhage

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  • Marius Mader - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Jörn Grensemann - Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
  • Stefan Kluge - Universitätsklinikum Hamburg-Eppendorf, Klinik für Intensivmedizin, Hamburg, Deutschland
  • Manfred Westphal - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland
  • Patrick Czorlich - Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Neurochirurgie, Hamburg, Deutschland

Deutsche Gesellschaft für Neurochirurgie. 69. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Mexikanischen und Kolumbianischen Gesellschaft für Neurochirurgie. Münster, 03.-06.06.2018. Düsseldorf: German Medical Science GMS Publishing House; 2018. DocV086

doi: 10.3205/18dgnc087, urn:nbn:de:0183-18dgnc0879

Published: June 18, 2018

© 2018 Mader et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

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Objective: Multidrug-resistant organisms (MDRO) are an increasing problem in critical care medicine. Despite this fact, no data on the rate of MDRO in patients with an aneurysmal subarachnoid hemorrhage (SAH) are published so far. This study describes for the first time the epidemiology and impact of MDRO in patients suffering from SAH.

Methods: Anonymous data of SAH patients admitted to our institution from November 2010 to August 2017 were retrospectively reviewed. Patients with microbiological tests positive for MDRO were identified. Screening of MDRO was in consensus with the national recommendation.

Results: 449 SAH patients were reviewed, 18 of these patients (prevalence: four MDRO-positive patients per 100 SAH patients) had positive tests for MDRO during their hospital stay. The prevalence upon admission was 1.3 MDRO-positive patients per 100 patients. The acquisition rate was 1.1 MDRO-positive patients per 1000 hospital days. The MDRO burden was 36.7 MDRO-positive days per 1000 hospital days. Gram-negative bacteria (n=11) were the most common organisms, less frequent were methicillin resistant S. aureus (MRSA, n=5) and vancomycin resistant Enterococcus spp. (VRE, n=2). An infection caused by MDRO was present in nine patients, which most frequently affected the respiratory tract. Patients positive for an MDRO had a significantly extended length of stay in intensive care (mean ± SD: 26.7 ± 13.0 versus 18.4 ± 11.7 days, p=0.004) and in hospital (mean ± SD: 33.9 ± 12.4 versus 24.4 ± 12.6 days, p=0.002). MDRO detection was associated with a significant prolonged duration of mechanical ventilation (median (IQR): 254.0 (14.9 - 632.8) versus 37.5 (3.3 - 277.0) hours, p=0.02). There was no statistically significant effect on the Glasgow Outcome Scale (GOS) at discharge and at follow-up after 164.4 ± 113.0 days.

Conclusion: MDRO positivity is present in 4% of aneurysmal SAH patients. It seems to be associated with a prolonged length of stay and prolonged duration of mechanical ventilation. The importance of infection control standards in neurointensive care units is emphasized.