Incidence of nosocomial infections in a neurosurgical intensive care unit

Critically ill neurosurgical patients are at high risk of acquiring nosocomial infections due to prolonged ventilatory support, extensive monitoring and due to special pharmacotherapy. The aim of our study was to investigate the incidence and facultative predisposing factors of hospital-acquired infections in this particular patient population. During a four-month period 48 patients admitted to a neurosurgical eight bed intensive care unit were prospectively studied for microbiological colonisation and infection rates. Screening for infectious complications was done following a standardized infection control protocol including microbiological and clinical parameters. 37% of all patients developed bacterial pneumonia and 15% suffered from septic syndrome. Only one patient developed a primary CNS infection due to a contaminated ICP monitoring device, while no case of proven infection due to contaminated arterial or central venous lines and urinary catheterization occurred. We did not establish any detrimental effect of prolonged corticosteroid administration to these special patients. Our results demonstrate that overall infection rates in critically ill neurosurgical patients are comparable to that reported for general ICU's. Although one patient suffered from a primary CNS infection, infectious complications are more related to mechanical Ventilation than to neurosurgical intervention and ICP-monitoring.