• Hugo Boechat Andrade, da SilvaIvan Rocha FerreiraIRFDepartment of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA., Rodolfo Espinoza, Marcel Treptow Ferreira, Mayara Secco Torres da Silva, Pedro Henrique Nascimento Theodoro, Paula João Tomás Detepo, Margareth Catoia Varela, Grazielle Viana Ramos, Aline Reis da Silva, Jesus Soares, Ermias D Belay, James J Sejvar, Fernando Augusto Bozza, José Cerbino-Neto, and André Miguel Japiassú.
• Instituto Nacional de Infectologia Evandro Chagas (INI), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ CEP 21040-360, Brazil; Sexually Transmitted Diseases Sector, Biomedical Institute, Federal Fluminense University (UFF), Niterói, RJ, Brazil. Electronic address: hugo.boechat@ini.fiocruz.br.
• J Crit Care. 2024 Feb 1; 79: 154451154451.

PurposeThe 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 MethodsWe 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.ResultsIn 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.ConclusionsPatients' 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.Copyright © 2023 Elsevier Inc. All rights reserved.

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