Incidence, Predictors, and Outcomes of Ventriculostomy-Associated Infections in Spontaneous Intracerebral Hemorrhage.
The impact of ventriculostomy-associated infections (VAI) on intracerebral hemorrhage (ICH) outcomes has not been clearly established, although prior studies have attempted to address the incidence and predictors of VAI. We aimed to explore VAI characteristics and its effect on ICH outcomes at a population level.



ICH patients requiring ventriculostomy with and without VAI were identified from 2002 to 2011 Nationwide Inpatient Sample using ICD-9 codes. A retrospective cohort study was performed. Demographics, comorbidities, hospital characteristics, inpatient outcomes, and resource utilization measures were compared between the two groups. Pearson's Chi-square and Wilcoxon-Mann-Whitney tests were used for categorical and continuous variables, respectively. Logistic regression was used to analyze the predictors of VAI.



We included 34,238 patients in the analysis, of whom 1934 (5.6 %) had VAI. The rate of ventriculostomy utilization in ICH increased from 5.7 % in 2002-2003 to 7.0 % in 2010-2011 (trend p < 0.001) and the rate of VAI also showed a gradual upward trend from 6.1 to 7.0 % across the same interval (trend p < 0.001). The VAI group had significantly higher inpatient mortality (41.2 vs. 36.5 %, p < 0.001) and it remained higher after controlling for baseline demographics, hospital characteristics, comorbidity, and systemic infections (adjusted OR 1.38, 95 % CI 1.22-1.46, p < 0.001). The VAI group had longer length of hospital stay and higher inflation adjusted cost of care. Predictors of VAI included higher age, males, higher Charlson's comorbidity scores, longer length of stay, and presence of systemic infections mainly pneumonia and sepsis.



VAI resulted in higher inpatient mortality, more unfavorable discharge disposition, and higher resource utilization measures in ICH patients. Steps to mitigate VAI may help improve ICH outcomes and decrease hospital costs.
Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD, 21287, USA. santoshbmurthy@gmail.com.
Santosh B
SB
Murthy
Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
Yogesh
Y
Moradiya
Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
Jharna
J
Shah
Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Daniel F
DF
Hanley
Division of Neurosciences Critical Care, Department of Neurology, Johns Hopkins University School of Medicine, 600 N Wolfe St, Phipps 455, Baltimore, MD, 21287, USA.
Wendy C
WC
Ziai
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000453:epidemiology*; D002543:Cerebral Hemorrhage / Q000453:epidemiology*; D058565:Cerebral Ventriculitis / Q000453:epidemiology*; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D014696:Ventriculostomy / Q000009:adverse effects / Q000706:statistics & numerical data*; D055815:Young Adult
Clinical outcome; Intracerebral hemorrhage; Meningitis; Nationwide inpatient sample; Ventriculitis; Ventriculostomy