Multidrug-resistant organisms (MDROs) in patients with subarachnoid hemorrhage (SAH)

Abstract

Patient care in a neurointensive care unit (neuro-ICU) is challenging. Multidrug-resistant organisms (MDROs) are increasingly common in the routine clinical practice. We evaluated the impact of infection with MDROs on outcomes in patients with subarachnoid hemorrhage (SAH). A single-center retrospective analysis of SAH cases involving patients treated in the neuro-ICU was performed. The outcome was assessed 6 months after SAH using the modified Rankin Scale [mRS, favorable (0-2) and unfavorable (3-6)]. Data were compared by matched-pair analysis. Patient characteristics were well matched in the MDRO (n = 61) and control (n = 61) groups. In this center, one nurse was assigned to a two-bed room. If a MDRO was detected, the patient was isolated, and the nurse was assigned to the patient infected with the MDRO. In the MDRO group, 29 patients (48%) had a favorable outcome, while 25 patients (41%) in the control group had a favorable outcome; the difference was not significant (p > 0.05). Independent prognostic factors for unfavorable outcomes were worse status at admission (OR = 3.1), concomitant intracerebral hematoma (ICH) (OR = 3.7), and delayed cerebral ischemia (DCI) (OR = 6.8). Infection with MRDOs did not have a negative impact on the outcome in SAH patients. Slightly better outcomes were observed in SAH patients infected with MDROs, suggesting the benefit of individual care.

Figure 1

MDRO distribution. MDRO multi drug resistant organism, distribution in the subgroup. ESBL extended-spectrum beta-lactamase producing bacteria (E.coli, K. pneumoniae, K. oxytoca), MRSA methicillin-resistant Staphylococcus aureus, 3 MDRGN multidrug resistant Gram-negative bacteria (E. coli, K. pneumoniae, P. aeruginosa), 4 MDRGN multidrug resistant Gram-negative bacteria (A. baumanii, K. pneumoniae, P. aeruginosa, E. aerogenes), VRE vancomycin-resistant Enterococcus. 4 patients with multiple infections (2 patients 3 MDRGN + VRE, 1 patient MRSA + ESBL, 1 patient VRE + 3MDRGN) resulting in 83 positive detections in total.