Abstracts

Rationale: Infectious complications in status epilepticus (SE) are frequent and may worsen course and outcome, requiring additional treatment on an ICU. The aim of this study was to determine incidence, time of onset during SE, as well as impact of infections on SE course, length of hospitalization, ICU stay, and outcome. Methods: Setting: This cohort study was approved by the local ethics committee. The University Hospital of Basel is an 855-bed tertiary care center, located in the city of Basel, Switzerland with over 30 000 admissions per year. Patients with SE are treated mainly in the ICU, which has 19 beds and about 1000 patient admissions per year. Records of patients hospitalized from 2005 to 2009 due to SE were selected from a prospectively collected EEG database were included. Microbiological data were extracted from an established database and cross-checked with clinical data and medical records. Refractory SE (RSE), SE duration and type, days on the ICU, as well as all infectious complications, comorbidities, and outcome were assessed. EEG reports were based on EEG interpretation by two board certified epileptologists [R. S. and S. R.]. All microbiological data were obtained from the computerized database of the infection control microbiology surveillance and cross-checked. Infections were diagnosed based on the patients clinical examination, radiological findings, laboratory testings, and microbiological results according to the CDC criteria.Results: 22.5% of 160 patients had infections during SE. Median age was 65 (17-91) years with a slight female predominance (88; 55%). Cardiopathy and metabolic disorders were the most frequent comorbidities, detected in 55 (34.4%) and 46 (28.8%) of all patients, respectively. Known epilepsy was present in 29 (18.1%) patients. Almost all infections during SE (94.4%) were respiratory tract infections, 29.4% were ventilator-associated pneumonias. Patients with infections during SE had longer mean course of SE (p<0.0001), longer mean ICU stay (p=0.0041), higher risk of RSE (OR: 4.8, p=0.0002), and higher mortality (OR: 5.2, p=0.0003) than those without infections. Analyzes of survival rates over time demonstrate significant differences between patients with all kinds of infections and with RTI during SE compared to patients without infections before or during SE (Figure 1). A trend to lower survival rate was seen in patients with VAP versus RTI without reaching significance (Figure 1). Most infections occurred in the first three days after SE onset (Figure 2 a). While infections detected before SE onset had no significant influence on SE duration, RSE rate and death, infections occurring in the first three days after SE onset significantly increased risk for all three endpoints (Figure 2 b and c).Conclusions: Nosocomial infections during the first three days of SE are frequent, leading to higher mortality, prolonged ICU stay, and RSE. Therefore, patients with SE should undergo intensive supportive care including intensified EEG-monitoring and antiepileptic treatment to combat infectious complications.