Wenjing Li,1,2,* Zixuan Hou,1,2,* Jinhua Chen,3,* Rong Pi,1,2 Hanwenxi Wang,1,2 Mengna Dai,1,2 Yan Ouyang,1 Suyun Li1 

1Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China; 2School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People’s Republic of China; 3Department of Obstetrics and Gynecology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430022, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yan Ouyang, Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People’s Republic of China, Email yan_ouyang@hust.edu.cn Suyun Li, Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, People’s Republic of China, Email 13986213577@163.com

Aim: Patients in the neurosurgical intensive critical unit (ICU) face high rates of malnutrition and multidrug-resistant (MDR) infections. This study aimed to investigated the correlation between malnutrition and MDR bacterial infections, aiming to offer novel strategies for preventing and controlling MDR infections from the perspective of nutritional management in clinical practice.
Methods: This retrospective cohort study analyzed 134 patients with MDR infections and 148 patients with non-MDR infections from November 2023 and May 2024 in neurosurgical ICU. MDR was defined as resistance to at least three antibiotic classes. Univariate, multivariate and correlation analyses were performed to explore the relationship between malnutrition and MDR infections.
Results: The incidence of malnutrition risk in the MDR group was significantly higher than in the non-MDR group (P < 0.05). After adjusting for confounding factors, malnutrition was still independently associated with an increased risk of MDR infections (OR = 2.336; 95% CI = 1.361~4.112, P =  0.002). Furthermore, C-reactive protein level was negatively correlated with TP (r = − 0.281, P < 0.001), ALB (r = − 0.267, P < 0.001), PLB (r = − 0.279, P < 0.001), Hb (r = − 0.167, P < 0.01) and PNI (r = − 0.257, P < 0.001), suggesting that higher infection severity was associated with poorer nutritional status. For bacterial strains, Acinetobacter baumannii accounted for the largest proportion in our study.
Conclusion: Malnutrition is an independent risk factor for MDR infection in neurosurgical ICU patients. This finding highlights the need for integrated interventions targeting malnutrition in MDR prevention for neurosurgical ICU patients.
Plain Language Summary: Neurosurgical intensive care unit patients are highly susceptible to malnutrition and multi-drug resistant infections.Malnutrition independently contributes to an increased risk of developing multi-drug resistant infections.In critically ill patients, a strong inverse correlation exists between inflammatory markers and nutritional status.Early nutritional interventions are essential in the prevention and management of multi-drug resistant infections in neurosurgical intensive care unit, improving patient outcomes.

Keywords: malnutrition, bacterial infections, multi-drug resistance, neurosurgical ICU