Trendy czasowe, cechy mikrobiologiczne i czynniki związane z infekcjami nabytymi w szpitalu u hospitalizowanych pacjentów neurologicznych: 8-letnie badanie retrospektywne

Abstract Background Healthcare-associated infections (HAIs) remain an important patient-safety challenge in neurological inpatients, who are often vulnerable because of impaired consciousness, airway dysfunction, immobility, invasive procedures and prolonged hospitalization. This study aimed to describe long-term temporal trends, microbiological characteristics and factors associated with HAIs among hospitalized neurological patients, and to develop an exploratory internally evaluated risk-estimation nomogram. Methods This retrospective observational study included patients admitted to the Departments of Neurology and Neurosurgery at Deyang People’s Hospital between January 2016 and December 2023. HAIs were identified according to national surveillance diagnostic criteria. Annual HAI incidence, infection sites, microbiological findings and multidrug-resistant organisms were summarized descriptively. Multivariable logistic regression was used to identify factors associated with HAI occurrence in the full analytic cohort. A nomogram based on clinically available variables was developed and internally evaluated using training and validation datasets. Results Among 45,166 eligible admissions, 1,046 patients developed HAIs, corresponding to an overall incidence of 2.3%. Annual HAI incidence decreased from 3.5% in 2016 to 1.1% in 2023. The infection burden was concentrated in lower respiratory tract and urinary tract infections. Gram-negative bacteria predominated among microbiological isolates, with Klebsiella pneumoniae and Escherichia coli being the leading pathogens. In multivariable analysis, older age, smoking, diabetes, history of epilepsy, neurological disease category and calendar year were associated with HAI occurrence. The internally evaluated nomogram showed high apparent discrimination, but its performance should be interpreted cautiously because of the single-centre retrospective design and the absence of temporal or external validation. Conclusion HAIs among hospitalized neurological patients declined over the 8-year period, but respiratory and urinary infections, Gram-negative organisms and multidrug-resistant pathogens remained the main infection-control challenges. The findings support targeted surveillance and prevention in clinically vulnerable neurological patients. The nomogram should be regarded as exploratory and requires further validation before clinical application.