The Incidence and Outcomes of Healthcare-associated Respiratory Tract Infections in Non-ventilated Neurocritical Care Patients: Results of a 10-year Prospective Cohort Study

Abstract

Background. The incidence of healthcare-associated respiratory tract infections in non-ventilated patients (NVA-HARTI) in neurosurgical intensive care units (ICU) is unknown. The impact of NVA-HARTI on patient outcomes and differences between NVA-HARTI and ventilator-associated healthcare-associated respiratory tract infections (VA-HARTI) are poorly understood. Our objectives were to report the incidence, hospital length of stay (LOS), ICU LOS, and mortality in neurosurgical ICU and compare these characteristics between NVA- and VA-HARTI.Methods. This prospective cohort study was conducted in a neurosurgical ICU in Moscow from 2011 to 2020. All patients with ICU LOS >48h were included. Time trends were analyzed for all outcomes. A competing risk model was used for survival and risk analysis.Results. A total of 3,937 ICU admissions were analyzed. NVA-HARTI vs VA-HARTI results were: cumulative incidence 7.2 (6.4-8.0) vs 15.4 (14.2-16.5) per 100 ICU admissions, incidence rate 4.2±2.0 vs 9.5±3.0 per 1000 patient-days in the ICU, median LOS 32 [21; 48.5] vs 46 [28; 76.5] days, median ICU LOS 15 [10; 28.75] vs 26 [17; 43] days, and mortality rates 12.3% (7.9-16.8) vs 16.7% (13.6-19.7). The incidence of VA-HARTI decreased in ten years while NVA-HARTI incidence did not change. VA-HARTI was found to be an independent risk factor of death, odds ratio 1.54 (1.11-2.14), p-value=0.009 while NVA-HARTI was not.Conclusion. Our findings suggest that NVA-HARTI in neurosurgical ICU patients represents a significant healthcare burden with relatively high incidence and associated poor outcomes. NVA-HARTI appeared to be different from VA-HARTI and persisted despite preventive measures; therefore, extrapolating VA-HARTI research findings to NVA-HARTI should be avoided.