Nosocomial infections in neurocritical care

Development of nosocomial infections is a commonly encountered problem for critically ill patients. Approximately half of all nosocomial pneumonias in the neurointensive care unit (NICU) are associated with ventilator-associated pneumonia. Prompt diagnosis with appropriate specimen analysis is required in order to prevent increased morbidity. Catheter-related blood stream infection imposes financial as well as medical implications. Multifaceted interventions are helpful to ensure adherence with evidence-based infection control guidelines. Urosepsis occurs in approximately 16% of patients. Colonized patients without evidence of infection do not require treatment, but the indwelling catheter should be changed. NICU patients have increased risk of developing cerebrospinal fluid infection due to frequent placement of external ventricular drains. The incidence of ventriculostomy-related meningitis or ventriculitis is approximately 8%. It is unclear whether the duration of ventricular catheter has any relationship with the risk of infection. Patients often receive multiple antibiotics, leading to an increased risk of developing Clostridium difficile colitis, which needs prompt diagnosis and appropriate antimicrobial therapy.