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2030-12-31
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- INI - Artigos de Periódicos [3392]
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CLINICAL FEATURES, ETIOLOGIES, AND OUTCOMES OF CENTRAL NERVOUS SYSTEM INFECTIONS IN INTENSIVE CARE: A MULTICENTRIC RETROSPECTIVE STUDY IN A LARGE BRAZILIAN METROPOLITAN AREA
Critical care
Encephalitis
In-hospital mortality
Meningitis
Meningoencephalitis
Prognosis
Surveillance
Author
Andrade, Hugo Boechat
Silva, Ivan Rocha Ferreira da
Espinoza, Rodolfo
Ferreira, Marcel Treptow
Silva, Mayara Secco Torres da
Theodoro, Pedro Henrique Nascimento
Detepo, Paula João Tomás
Varela, Margareth Catoia
Ramos, Grazielle Viana
Silva, Aline Reis da
Soares, Jesus
Belay, Ermias D.
Sejvar, James J.
Bozza, Fernando Augusto
Cerbino-Neto, José
Japiassú, André Miguel
Silva, Ivan Rocha Ferreira da
Espinoza, Rodolfo
Ferreira, Marcel Treptow
Silva, Mayara Secco Torres da
Theodoro, Pedro Henrique Nascimento
Detepo, Paula João Tomás
Varela, Margareth Catoia
Ramos, Grazielle Viana
Silva, Aline Reis da
Soares, Jesus
Belay, Ermias D.
Sejvar, James J.
Bozza, Fernando Augusto
Cerbino-Neto, José
Japiassú, André Miguel
Affilliation
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Federal Fluminense University. Biomedical Institute. Sexually Transmitted Diseases Sector. Niterói, RJ, Brazil.
Department of Neurological Sciences. Rush University Medical Center. Chicago, IL, USA.
Copa Star Hospital. Surgical Intensive Care Unit. Rio de Janeiro, RJ, Brazil / National Cancer Institute. Intensive Care Unit II. Rio de Janeiro, RJ, Brazil.
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.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Immunization and Health Surveillance Research Laboratory. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
Division of High-Consequence Pathogens and Pathology. National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Atlanta, GA, USA.
Division of High-Consequence Pathogens and Pathology. National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Atlanta, GA, USA.
Division of High-Consequence Pathogens and Pathology. National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Atlanta, GA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Immunization and Health Surveillance Research Laboratory. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil.
Department of Neurological Sciences. Rush University Medical Center. Chicago, IL, USA.
Copa Star Hospital. Surgical Intensive Care Unit. Rio de Janeiro, RJ, Brazil / National Cancer Institute. Intensive Care Unit II. Rio de Janeiro, RJ, Brazil.
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.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil / Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Immunization and Health Surveillance Research Laboratory. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
Division of High-Consequence Pathogens and Pathology. National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Atlanta, GA, USA.
Division of High-Consequence Pathogens and Pathology. National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Atlanta, GA, USA.
Division of High-Consequence Pathogens and Pathology. National Center for Emerging and Zoonotic Infectious Diseases. Centers for Disease Control and Prevention. Atlanta, GA, USA.
Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / D'Or Institute for Research and Education. Department of Critical Care. Rio de Janeiro, RJ, Brazil.
Oswaldo Cruz Foundation. Evandro Chagas National Institute of Infectious Diseases. Immunization and Health Surveillance Research Laboratory. Rio de Janeiro, RJ, Brazil / D'Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.
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 infectionCritical care
Encephalitis
In-hospital mortality
Meningitis
Meningoencephalitis
Prognosis
Surveillance
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