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Associations between infections and clinical outcome parameters in status epilepticus : a retrospective 5-year cohort study

Sutter, Raoul and Tschudin-Sutter, Sarah and Grize, Leticia and Fuhr, Peter and Bonten, Marc J. M. and Widmer, Andreas F. and Marsch, Stephan and Rüegg, Stephan. (2012) Associations between infections and clinical outcome parameters in status epilepticus : a retrospective 5-year cohort study. Epilepsia : journal of the International League against Epilepsy, Vol. 53, H. 9. pp. 1489-1497.

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Official URL: http://edoc.unibas.ch/dok/A6094076

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Abstract

PURPOSE: Status epilepticus (SE) represents a life-threatening condition, requiring pharmacologic therapy and neurointensive care. Infectious complications in SE are suspected to be frequent and worsen outcome. However, little is known about their incidence during SE and their impact on course and outcome. The aim of this study was to determine the incidence and time of onset of infections during SE, as well as their association with particular SE courses, length of hospitalization, intensive care unit (ICU) stay, and outcome. METHODS: All consecutive ICU patients hospitalized due to SE from 2005 to 2009 at the University Hospital Basel were included. Electroencephalography (EEG) recordings and microbiologic data were extracted from two prospectively established databases. Length of SE, ICU, and hospital stay; development of refractory status epilepticus (RSE); and destinations at discharge or death were assessed by comprehensive medical chart review. KEY FINDINGS: Of 160 patients, 23% had infections during SE. Of those, 94% were respiratory tract infections, 29% were ventilator-associated pneumonias. Patients with infections during SE had longer SE duration (p > 0.0001), longer ICU stay (p = 0.0041), higher risk of RSE (odds ratio [OR] 4.8, p = 0.0002), and higher mortality (OR 5.2, p = 0.0003) than those without infectious complications. Infections during the first 3 days after SE onset were significantly associated with longer SE duration, higher rate of RSE, and higher mortality compared to infections detected before SE. SIGNIFICANCE: Infections during SE are frequent and associated with higher mortality, prolonged ICU stay, and higher rates of RSE. Further trials are needed to provide evidence of a causative relation between infections and outcomes of SE, followed by investigations on underlying mechanisms and preventive strategies.
Faculties and Departments:09 Associated Institutions > Swiss Tropical and Public Health Institute (Swiss TPH) > Department of Epidemiology and Public Health (EPH) > Biostatistics
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Neurologie
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Neurologie
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Infektiologie > Infektiologie (Battegay M)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Infektiologie > Infektiologie (Battegay M)
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Intensivmedizin
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Intensivmedizin
03 Faculty of Medicine > Bereich Medizinische Fächer (Klinik) > Intensivmedizin > Intensivmedizin (Marsch)
03 Faculty of Medicine > Departement Klinische Forschung > Bereich Medizinische Fächer (Klinik) > Intensivmedizin > Intensivmedizin (Marsch)
03 Faculty of Medicine
UniBasel Contributors:Grize, Leticia and Sutter, Raoul Christian and Tschudin Sutter, Sarah
Item Type:Article, refereed
Article Subtype:Research Article
Bibsysno:Link to catalogue
Publisher:Elsevier
ISSN:0013-9580
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:09 Jan 2015 09:25
Deposited On:19 Jul 2013 07:39

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