Assessment of surgical risk factors in the development of ventilator-associated pneumonia in neurosurgical intensive care unit patients: Alarming observations

Sachdeva, Deepashu; Singh, Daljit; Loomba, Poonam; Kaur, Amandeep; Tandon, Monica; Bishnoi, Ishu

doi:10.4103/neuroindia.ni_814_16

Cited by 15 publications

(7 citation statements)

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“…As previously reported, the mortality rate of meningitis/encephalitis in post-neurosurgical patients ranges from 15% to 35%, 20,21 and consistent with these prior studies, the total in-hospital mortality rate for the diagnosis of Enterobacteriaceae meningitis/encephalitis in our study was 23.2%. Many previous studies have only shown the risk factors of neurosurgical infection, which include percentage of males, CSF leakage, surgical diagnosis, surgeon, early reoperation, surgical duration, EVD, LD, diabetes, and so on.…”

Section: Discussionsupporting

confidence: 92%

Longitudinal Analysis of Risk Factors for Clinical Outcomes of Enterobacteriaceae Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014–2019

Shi

Zheng

Qian

et al. 2020

IDR

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Purpose Our study is a retrospective observational study conducted in one of the largest clinical centers of neurosurgery in China. We aimed to investigate the antimicrobial susceptibility patterns of the Enterobacteriaceae isolates responsible for nosocomial meningitis/encephalitis in post-neurosurgical patients. Meanwhile, we tried to evaluate the risk factors for mortality following Enterobacteriaceae meningitis/encephalitis. Patients and Methods Medical data on clinical characteristics, antibiotic susceptibilities, and mortality were reviewed until patients’ discharge or death in the hospital. Data for a total of 164 cerebrospinal fluid (CSF) infection cases due to Enterobacteriaceae after neurosurgery were collected between January 2014 and November 2019 in order to identify risk factors affecting the outcome. Kaplan–Meier survival analysis and multivariable Cox proportional hazard models were applied. Results In this study, a total of 2416 neurosurgical meningitis/encephalitis cases were reported between 2014 and 2019. Enterobacteriaceae accounted for 7.3% (176/2416) of all the bacterial infections. Of them, 164 Enterobacteriaceae isolates were available to divide into two groups according to the final outcome of whether the patient died or survived. In total, 38 patients died (23.2%) and 126 patients survived (76.8%). The most frequent infecting species was Klebsiella pneumoniae (47.0%, 77/164). Fourteen-day and 30-day mortality rates were 7.9% (13/164) and 15.2% (25/164). Kaplan–Meier survival analysis revealed that the risk factors of Enterobacteriaceae meningitis/encephalitis that resulted in poor outcomes included comorbidities, Glasgow Coma Scale (GCS) score, sepsis, intensive care unit (ICU) admission, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae , and ventilation. A GCS score of less than or equal to 8 (P=0.04, HR 2.562) was identified to be a significant risk factor for mortality according to the multivariable Cox proportional hazards model. Conclusion In-hospital mortality caused by Enterobacteriaceae meningitis/encephalitis in neurosurgery was high. A GCS score of ≤8 was an independent risk factor for mortality following Enterobacteriaceae meningitis/encephalitis in post-neurosurgical patients.

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Section: Discussionsupporting

confidence: 92%

Longitudinal Analysis of Risk Factors for Clinical Outcomes of Enterobacteriaceae Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014–2019

Shi

Zheng

Qian

et al. 2020

IDR

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“…MiR‐1247 could inhibit LPS‐induced acute pneumonia in A549 cells 18 . MiR‐155 regulates the immune response to bacterial pneumonia, 19 and miR‐21 may affect the function of macrophages to promote the occurrence and development of pneumonia 20 . Here, we found out a new miRNA, miR‐495, was downregulated in serum of patients with acute stage pneumonia, suggesting a potential therapeutical target in acute pneumonia.…”

Section: Discussionmentioning

confidence: 75%

“…18 MiR-155 regulates the immune response to bacterial pneumonia, 19 and miR-21 may affect the function of macrophages to promote the occurrence and development of pneumonia. 20 Here, we found out a new miRNA, miR-495, was downregulated in serum of patients with acute stage pneumonia, suggesting a potential therapeutical target in acute pneumonia. Generally, LPS, as the main pathogenic component of gram negative bacteria, 21 directly binds with monocyte or Toll like receptor 4 on macrophage, thus leading to the release of inflammatory cytokines, sepsis and pneumonia.…”

Section: Discussionmentioning

confidence: 75%

miR‐495 targets ROCK1 to inhibit lipopolysaccharides‐induced WI‐38 cells apoptosis and inflammation

Zhang

Xiang

Liu

et al. 2020

The Kaohsiung J of Med Scie

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Pneumonia is an inflammatory disease with leading mortality rate in children. It has been well established that microRNAs (miRNAs) have been regarded as critical regulator in acute lung injury. We intended to explore the effect and underlying mechanism of miR‐495 on lipopolysaccharides (LPS)‐induced WI‐38 cells. Here, we first found that miR‐495 was downregulated in serum of patients with acute stage pneumonia. To establish cell model of acute pneumonia, WI‐38 cells were treated with 20 μg/mL LPS, and qRT‐PCR analysis also confirmed the downregulation of miR‐495 in LPS‐induced WI‐38 cells. Data from MTT (3‐[4,5‐dimethylthiazol‐2‐yl]‐2,5‐diphenyltetrazolium bromide) and flow cytometry assays showed that the decreased cell viability and induced cell apoptosis by LPS treatment were also reversed by miR‐495 over‐expression. Moreover, miR‐495 inhibited expression of associated inflammatory factors, which were induced by LPS treatment. Second, ROCK1 (rho‐associated, coiled‐coil‐containing protein kinase 1) was identified as functional target gene of miR‐495, whose expression was decreased by miR‐495. Mechanically, combination of miR‐495 and ROCK1 over‐expression reversed the influence of miR‐495 on LPS‐induced inflammation, viability, and apoptosis. In conclusion, our findings indicated that miR‐495 inhibited LPS‐induced inflammation injury and apoptosis in WI‐38 cells via targeting ROCK1, which would shed light on therapeutic schedule in acute pneumonia.

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“…Staffed with experts trained in advanced diagnostics and patient care, neuro-ICUs address the complex needs of patients with nervous system damage, aiming to improve their ability to move and communicate. Neuro-ICUs, however, face challenges with patients post neurosurgery, who may develop pulmonary complications, necessitating frequent radiological exams that contribute to significant cumulative radiation doses [ 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Radiation Overuse in Intensive Care Units

Zanon,

Bini,

Toniolo

et al. 2024

Tomography

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Radiological imaging is essential for acute patient management in Intensive Care Units (ICUs); however, it introduces the risk of exposure to ionizing radiation. This review synthesizes research on radiation exposure in ICU settings, highlighting its rise during the COVID-19 pandemic and the rise in repetitive imaging. Our analysis extends to radiation safety thresholds, revealing that some ICU patients exceed the diagnostic reference level, emphasizing the need to balance diagnostic utility against potential long-term risks, such as cancer. Prospective studies have demonstrated an increase in the median cumulative effective dose in patients with trauma over time, prompting calls for improved awareness and monitoring. Moreover, innovative dose-reduction strategies and optimized protocols, especially in neuro-ICUs, promise to mitigate these risks. This review highlights the essential but risky role of radiological imaging in critical care. It advocates for rigorous radiation management protocols to safeguard patient health while ensuring the continuity of high-quality medical care.

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Assessment of surgical risk factors in the development of ventilator-associated pneumonia in neurosurgical intensive care unit patients: Alarming observations

Cited by 15 publications

References 0 publications

<p>Longitudinal Analysis of Risk Factors for Clinical Outcomes of <em>Enterobacteriaceae</em> Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014–2019</p>

<p>Longitudinal Analysis of Risk Factors for Clinical Outcomes of <em>Enterobacteriaceae</em> Meningitis/Encephalitis in Post-Neurosurgical Patients: A Comparative Cohort Study During 2014–2019</p>

miR‐495 targets ROCK1 to inhibit lipopolysaccharides‐induced WI‐38 cells apoptosis and inflammation

Radiation Overuse in Intensive Care Units

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