title: Nosocomial Infections and Outcomes after Intracerebral Hemorrhage: A Population-Based Study.
abstract: Infections after intracerebral hemorrhage (ICH) may be associated with worse outcomes. We aimed to evaluate the association between nosocomial infections (>48 h) and outcomes of ICH at a population level.
  
  
  
  We identified patients with ICH using ICD-9-CM codes in the 2002-2011 Nationwide Inpatient Sample. Demographics, comorbidities, surgical procedures, and hospital characteristics were compared between patients with and without concomitant nosocomial infections. Primary outcomes were in-hospital mortality and home discharge. Secondary outcome was permanent cerebrospinal shunt placement. Logistic regression analyses were used to analyze the association between infections and outcomes.
  
  
  
  Among 509,516 ICH patients, infections occurred in 117,636 (23.1 %). Rates of infections gradually increased from 18.7 % in 2002-2003 to 24.1 % in 2010-2011. Pneumonia was the most common nosocomial infection (15.4 %) followed by urinary tract infection (UTI) (7.9 %). Patients with infections were older (p < 0.001), predominantly female (56.9 % vs. 47.9 %, p < 0.001), and more often black (15.0 % vs. 13.4 %, p < 0.001). Nosocomial infection was associated with longer hospital stay (11 vs. 5 days, p < 0.001) and a more than twofold higher cost of care (p < 0.001). In the adjusted regression analysis, patients with infection had higher odds of mortality [odds ratio (OR) 2.11, 95 % CI 2.08-2.14] and cerebrospinal shunt placement (OR 2.19, 95 % CI 2.06-2.33) and lower odds of home discharge (OR 0.49, 95 % CI 0.47-0.51). Similar results were observed in subgroup analyses of individual infections.
  
  
  
  In a nationally representative cohort of ICH patients, nosocomial infection was associated with worse outcomes and greater resource utilization.
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA. sam9200@med.cornell.edu.|Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA. sam9200@med.cornell.edu.
authors.forename: Santosh B
authors.initials: SB
authors.lastname: Murthy
authors.affiliation: Department of Neurosurgery, Northwell Long Island Jewish School of Medicine, New York, NY, USA.
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Moradiya
authors.affiliation: Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Jharna
authors.initials: J
authors.lastname: Shah
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.
authors.forename: Alexander E
authors.initials: AE
authors.lastname: Merkler
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.
authors.forename: Halinder S
authors.initials: HS
authors.lastname: Mangat
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.|Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Costantino
authors.initials: C
authors.lastname: Iadacola
authors.affiliation: Division of Brain Injury Outcomes, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Daniel F
authors.initials: DF
authors.lastname: Hanley
authors.affiliation: Division of Stroke and Neurocritical Care, Department of Neurology, Weill Cornell Medical College, 525 E 68th Street, New York, NY, 10065, USA.|Clinical and Translational Neuroscience Unit, Feil Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Hooman
authors.initials: H
authors.lastname: Kamel
authors.affiliation: Division of Neurosciences Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Ziai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy*; D003428:Cross Infection / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Clinical outcome; Infections; Intracerebral hemorrhage; Meningitis; Nationwide inpatient sample; Pneumonia; Sepsis; Urinary tract infection