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Multicenter Study
. 2024 Feb:79:154451.
doi: 10.1016/j.jcrc.2023.154451. Epub 2023 Oct 21.

Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area

Hugo Boechat Andrade  1 , Ivan Rocha Ferreira da Silva  2 , Rodolfo Espinoza  3 , Marcel Treptow Ferreira  4 , Mayara Secco Torres da Silva  4 , Pedro Henrique Nascimento Theodoro  4 , Paula João Tomás Detepo  4 , Margareth Catoia Varela  5 , Grazielle Viana Ramos  6 , Aline Reis da Silva  6 , Jesus Soares  7 , Ermias D Belay  7 , James J Sejvar  7 , Fernando Augusto Bozza  8 , José Cerbino-Neto  9 , André Miguel Japiassú  4
Affiliations
Multicenter Study

Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: A multicentric retrospective study in a large Brazilian metropolitan area

Hugo Boechat Andrade et al. J Crit Care. 2024 Feb.

Abstract

Purpose: The goal of this study was to investigate severe central nervous system infections (CNSI) in adults admitted to the intensive care unit (ICU). We analyzed the clinical presentation, causes, and outcomes of these infections, while also identifying factors linked to higher in-hospital mortality rates.

Materials and methods: We conducted a retrospective multicenter study in Rio de Janeiro, Brazil, from 2012 to 2019. Using a prediction tool, we selected ICU patients suspected of having CNSI and reviewed their medical records. Multivariate analyses identified variables associated with in-hospital mortality.

Results: In a cohort of 451 CNSI patients, 69 (15.3%) died after a median 11-day hospitalization (5-25 IQR). The distribution of cases was as follows: 29 (6.4%) had brain abscess, 161 (35.7%) had encephalitis, and 261 (57.8%) had meningitis. Characteristics: median age 41 years (27-53 IQR), 260 (58%) male, and 77 (17%) HIV positive. The independent mortality predictors for encephalitis were AIDS (OR = 4.3, p = 0.01), ECOG functional capacity limitation (OR = 4.0, p < 0.01), ICU admission from ward (OR = 4.0, p < 0.01), mechanical ventilation ≥10 days (OR = 6.1, p = 0.04), SAPS 3 ≥ 55 points (OR = 3.2, p = 0.02). Meningitis: Age > 60 years (OR = 234.2, p = 0.04), delay >3 days for treatment (OR = 2.9, p = 0.04), mechanical ventilation ≥10 days (OR = 254.3, p = 0.04), SOFA >3 points (OR = 2.7, p = 0.03). Brain abscess: No associated factors found in multivariate regression.

Conclusions: Patients' overall health, prompt treatment, infection severity, and prolonged respiratory support in the ICU all significantly affect in-hospital mortality rates. Additionally, the implementation of CNSI surveillance with the used prediction tool could enhance public health policies.

Trial registration: ClinicalTrials.gov NCT05370573.

Keywords: Central nervous system infection; Critical care; Encephalitis; In-hospital mortality; Meningitis; Meningoencephalitis; Prognosis; Surveillance.

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Conflict of interest statement

Declaration of Competing Interest The authors declare no conflicts of interest in writing this manuscript.

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