Produção Nacional
Epidemiology and Prognosis of Central Nervous System Infections in Intensive Care: A Multicentric Retrospective Study for Sentinel Surveillance in a Large Brazilian Metropolitan Area
2022; RELX Group (Netherlands); Linguagem: Inglês
10.2139/ssrn.4261835
ISSN1556-5068
AutoresHugo Boechat Andrade, Ivan Da Silva, Rodolfo Espinoza, Marcel Treptow Ferreira, Mayara Secco Torres Silva, Pedro Henrique Nascimento Theodoro, Paula João Tomás Detepo, Margareth Catoia Varela, Grazielle Viana Ramos, Aline Reis da Silva, Jesus Soares, Ermias D. Belay, James J. Sejvar, Fernando A. Bozza, José Cerbino-Neto, André Miguel Japiassú,
Tópico(s)Long-Term Effects of COVID-19
ResumoBackground: Intensive care units (ICU) could serve as good surveillance sites for encephalitis and other central nervous system infections (CNSI). While these surveillance systems are unpublished in Brazil, there is a lack of information on the short-term prognosis of critically ill patients with CNSI in the country.Methods: Retrospective multicenter study in the metropolitan area of Rio de Janeiro - Brazil, from 2012 to 2019. Patients in an ICU benchmarking database selected as suspected cases of CNSI, by a prediction tool, had their medical records reviewed. The outcome variable was in-hospital mortality; Kaplan–Meier curve and Cox proportional-hazard models were performed.Findings: 69 (15·3%) of 451 patients (6·43% with brain abscess, 35·69% with encephalitis, 57·87% with meningitis) died 11 (5-25 IQR) after hospitalization. Characteristics: median age of 41 (27-53 IQR) years, 58% male, 17% HIV positive. In-hospital mortality was independently associated with admission to ICU originating from the ward (adjusted hazard-ratio=1·66, p=0·002), age ≥60 years-old (aHR=2·57, p=0·009), HIV/AIDS (aHR=2·98, p=0·010), syndromic diagnosis of encephalitis (aHR=3·21, p=0·010), chronic CNSI (>30 days) (aHR=2·91, p=0·0018), time from onset of symptoms to start of treatment>three days (aHR=1·67, p=0·014), coma (GCS≤8) (aHR=2, p=0·011) and sepsis (aHR=2·01, p=0·018).Interpretation: Not only the clinical severity of the infection and its duration influence the outcome, but also the quality and speed of allocation and treatment of CNSI. Also, the surveillance of CNSI in large ICU settings, with the developed prediction tool, is possible and feasible.Funding: No additional funding source was required for this study.Declaration of Interest: The authors declare no conflicts of interestEthical Approval: This study was approved by the Institutional Review Board (IRB) from the Evandro Chagas National Institute of Infectious Diseases (INI - Instituto Nacional de Infectologia), IRB 16876819.9.0000.5262, and all co-participant institutions, which waived the need for informed consent, as the data were analyzed retrospectively and anonymously, without interventions.
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