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

Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Universidade Federal Fluminense. Instituto Biomédico. Departamento de Microbiologia e Parasitologia. Setor de Doenças Sexualmente Transmissíveis. Niterói, RJ, Brasil.
Rush University Medical Center. Department of Neurological Sciences. Chicago, IL, USA.
Hospital Copa Star. Unidade Pós-Operatória. Rio de Janeiro, RJ, Brasil / Instituto Nacional de Câncer. Hospital do Câncer II. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Instituto D'Or de Pesquisa e Ensino. Departamento de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa em Imunização e Vigilância em Saúde. Rio de Janeiro, RJ, Brasil.
Instituto D'Or de Pesquisa e Ensino. Departamento de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.
Instituto D'Or de Pesquisa e Ensino. Departamento de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.
National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Division of High-Consequence Pathogens and Pathology. Atlanta, GA, USA.
National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Division of High-Consequence Pathogens and Pathology. Atlanta, GA, USA.
National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Division of High-Consequence Pathogens and Pathology. Atlanta, GA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Instituto D'Or de Pesquisa e Ensino. Departamento de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Laboratório de Pesquisa em Imunização e Vigilância em Saúde. Rio de Janeiro, RJ, Brasil / Instituto D'Or de Pesquisa e Ensino. Departamento de Tratamento Intensivo. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.

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.

Keywords

Central nervous system infection
Encephalitis
Meningoencephalitis
Meningitis
Critical care
Surveillance
Prognosis
In-hospital mortality

Publisher

Elsevier

Citation

ANDRADE, Hugo Boechat et al. Clinical features, etiologies, and outcomes of central nervous system infections in intensive care: a multicentric retrospective study in a large brazilian metropolitan area. Journal of Critical Care, n. 79, p. 1-11, 2024.

DOI

10.1016/j.jcrc.2023.154451

ISSN

0883-9441

Please use this identifier to cite or link to this item: https://www.arca.fiocruz.br/handle/icict/61919

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Copyright

Restricted access

Embargo date

2030-12-31

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