Research Reports - Left brain injury associated with more hospital-acquired infections during inpatient rehabilitation

Arch Phys Med Rehabil. 2012 Oct 31

Frisina PG, Kutlik AM, Barrett AM

OBJECTIVE: Hospital-acquired infections (HAI) predict prolonged hospital stay,
significant disability, and mortality after stroke and brain injury. Based upon
previous animal and human studies, we hypothesized that a left-dominant brain
immune network (LD-BIN) might affect the occurrence of infection during inpatient
rehabilitation of stroke and traumatic brain injury [TBI]. DESIGN: A
retrospective analysis was performed on electronic medical records between
January 2009 and December 2010. All patients with left or right sided stroke or
TBI was included into the study. The LD-BIN hypothesis was tested by comparing
HAI rates depending on whether they had left or right brain lesions. SETTING: a
large inpatient rehabilitation hospital (Kessler Institute for Rehabilitation).
PARTICIPANTS: Among the 2,236 stroke and TBI patients with either a left or
right-sided brain lesion, 163 patients were identified with HAI. INTERVENTIONS:
not applicable. RESULTS: In the 163 patients identified with HAI with a diagnosis
of stroke or TBI, Chi-square (χ2) analysis revealed a significantly higher
proportion of HAI among left (n = 98; 60.1%) relative to right brain (n = 65;
39.9%) -injured patients (χ2 = 6.68, p < .01). These effects could not be
attributed to either clinical or demographic factors. CONCLUSION: Our findings
are consistent with the hypothesis that a LD-BIN may mediate vulnerability to
infection during rehabilitation of stroke and TBI patients. Further translational
research investigating novel means of managing patients based on brain lesion
location, and modulating the LD-BIN via behavioral and physiologic interventions,
may result in neuroscience-based methods to improve infection resistance in
braininjured patients.

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