title: Nosocomial bloodstream infections in neurosurgery: a 10-year analysis in a center with high antimicrobial drug-resistance prevalence.
abstract: Data on nosocomial bloodstream infections (NBSI) in neurosurgery is limited. This study aimed to analyze the epidemiology, microbiology, outcome, and risk factors for death in neurosurgical patients with NBSI in a multidrug resistant setting.
  
  
  
  Neurosurgical patients with a confirmed NBSI within the period 2003-2012 were retrospectively analyzed. NBSI was diagnosed when a pathogen was isolated from a blood sample obtained after the first 48 h of hospitalization. Patients' demographic, clinical, and microbiological data were recorded and analyzed using univariate and multivariate analysis.
  
  
  
  A total of 236 patients with NBSI were identified and 378 isolates were recovered from blood cultures. Incidence of NBSI was 4.3 infections/1000 bed-days. Gram-negative bacteria slightly predominated (54.5 %). The commonest bacteria were coagulase-negative staphylococci (CoNS, 26 %), Klebsiella pneumoniae (15.3 %), Pseudomonas aeruginosa (14.8 %), and Acinetobacter baumannii (13.2 %). Carbapenem resistance was found in 90 % of A. baumannii, in 66 % of P. aeruginosa, and in 22 % (2003-2007) to 77 % (2008-2012) of K. pneumoniae isolates (p < 0.05). Most CoNS and Staphylococcus aureus isolates (94 and 80 %, respectively) were methicillin-resistant. All Gram-negative isolates were sensitive to colistin and all Gram-positive isolates were sensitive to vancomycin and linezolid. Antimicrobial consumption decreased after 2007 (p < 0.05). Overall mortality was 50.4 %. In multivariate analysis, advanced age and stay in an Intermediate Care Unit (IMCU) were independent risk factors for in-hospital mortality (p < 0.05).
  
  
  
  Overall, high incidence of NBSI and considerable resistance of Gram-positive and particularly Gram-negative bacteria were noted in neurosurgical patients. Mortality was high with advanced age and stay in IMCU being the most important death-related factors.
authors.affiliation: 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece. ptsitsopoulos@auth.gr.
authors.forename: Parmenion P
authors.initials: PP
authors.lastname: Tsitsopoulos
authors.affiliation: Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece.|3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Elias
authors.initials: E
authors.lastname: Iosifidis
authors.affiliation: Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece.|3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Antachopoulos
authors.affiliation: 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Dimitrios M
authors.initials: DM
authors.lastname: Anestis
authors.affiliation: Department of Microbiology, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Ekaterini
authors.initials: E
authors.lastname: Karantani
authors.affiliation: Department of Microbiology, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Angeliki
authors.initials: A
authors.lastname: Karyoti
authors.affiliation: 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papaevangelou
authors.affiliation: 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Eftychios
authors.initials: E
authors.lastname: Kyriazidis
authors.affiliation: Infectious Diseases Unit, Hippokration General Hospital, Thessaloniki, Greece.|3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Roilides
authors.affiliation: 2nd Department of Neurosurgery, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Tsonidis
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000145:classification / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data
keywords: Bacteremia; Multi-resistant bacteria; Neurosurgery; Nosocomial bloodstream infection; Outcome; Sepsis