{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T17:08:23Z","timestamp":1789664903070,"version":"4.0.1"},"reference-count":42,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Epilepsia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study was undertaken to identify the incidence of respiratory tract infections (RTIs) in a large cohort of adult patients with status epilepticus (SE) and to characterize their associations with clinical features and outcome determinants.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective observational study in the intensive care unit (ICU) at the University Hospital of Basel, Switzerland from 2005\u20132024. All adult patients treated for SE at the ICU were included. We recorded the incidence of RTI diagnosed during or 48\u2009h after SE termination and clinical characteristics. Outcome characteristics potentially complicated by RTI (i.e., SE duration, hospital stay, survival with return to premorbid neurological function at hospital discharge, and mortality) were secondary objectives.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 818 patients (median age\u2009=\u200968\u2009years, 49% female), 34.2% required mechanical ventilation. RTIs were diagnosed in 12.0% (98\/818), rising to 34.3% (96\/280) among ventilated patients, with 21.4% (21\/98) meeting ventilator\u2010associated pneumonia criteria. Characteristics associated with subsequent RTI included nonconvulsive SE (NCSE) with coma, unconsciousness at onset, and early intubation (odds ratio [OR]\u2009=\u20091.8\u20132.6); 53.4% (31\/58) of patients with all three features developed RTIs. Patients with RTI had higher maximal median markers of inflammation (C\u2010reactive protein with RTI 81\u2009mg\/L vs. without RTI 23\u2009mg\/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001; leukocytes with RTI 11 \u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L vs. leukocytes without RTI 10 \u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.002). After adjusting for age, etiology, and SE severity, RTI remained associated with an 8.44\u2010day increase in SE duration (95% confidence interval [CI] =\u20095.31\u201311.56), a 54% reduced likelihood of full neurologic recovery (OR\u2009=\u2009.46; 95% CI = .26\u2013.81), and more than double the risk of in\u2010hospital mortality (OR\u2009=\u20092.12, 95% CI\u2009=\u20091.13\u20134.00).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Significance<\/jats:title>\n                    <jats:p>RTIs affect more than one third of mechanically ventilated patients with SE and approximately every second intubated patient with NCSE and coma. RTIs were associated with coma, early intubation, higher mortality, and longer SE duration. Prospective studies are needed to clarify the direction of these associations and whether preventing RTIs improves outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/epi.70458","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:13:33Z","timestamp":1789661613000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence and impact of respiratory tract infections on outcomes in patients with status epilepticus: A 20\u2010year longitudinal observation"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-0654-6479","authenticated-orcid":false,"given":"Sebastian","family":"Berger","sequence":"first","affiliation":[{"name":"Clinic for Intensive Care Medicine, Department of Acute Medicine University Hospital Basel  Basel Switzerland"},{"name":"Interdepartmental Division of Critical Care Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4762-1408","authenticated-orcid":false,"given":"Sira M.","family":"Baumann","sequence":"additional","affiliation":[{"name":"Clinic for Intensive Care Medicine, Department of Acute Medicine University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1557-9062","authenticated-orcid":false,"given":"Urs","family":"Fisch","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Hert","sequence":"additional","affiliation":[{"name":"Clinic for Intensive Care Medicine, Department of Acute Medicine University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6723-320X","authenticated-orcid":false,"given":"Pascale","family":"Grzonka","sequence":"additional","affiliation":[{"name":"Clinic for Intensive Care Medicine, Department of Acute Medicine University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3648-3609","authenticated-orcid":false,"given":"Sabina","family":"Hunziker","sequence":"additional","affiliation":[{"name":"Medical Communication and Psychosomatic Medicine University Hospital Basel  Basel Switzerland"},{"name":"Medical Faculty, University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5836-622X","authenticated-orcid":false,"given":"Stephan","family":"R\u00fcegg","sequence":"additional","affiliation":[{"name":"Department of Neurology University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4875-5368","authenticated-orcid":false,"given":"Sarah","family":"Tschudin\u2010Sutter","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Basel  Basel Switzerland"},{"name":"Division of Infectious Diseases, Department of Acute Medicine University Hospital Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6575-356X","authenticated-orcid":false,"given":"Raoul","family":"Sutter","sequence":"additional","affiliation":[{"name":"Clinic for Intensive Care Medicine, Department of Acute Medicine University Hospital Basel  Basel Switzerland"},{"name":"Department of Neurology University Hospital Basel  Basel Switzerland"},{"name":"Medical Faculty, University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"crossref","DOI":"10.1186\/s12931-023-02456-9","article-title":"Ventilator\u2010associated pneumonia in neurocritically ill patients: insights from the ENIO international prospective observational study","volume":"24","author":"Battaglini D","year":"2023","journal-title":"Respir Res"},{"key":"e_1_2_13_3_1","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.jocn.2021.12.035","article-title":"The incidence and outcomes of healthcare\u2010associated respiratory tract infections in non\u2010ventilated neurocritical care patients: results of a 10\u2010year cohort study","volume":"97","author":"Ershova K","year":"2022","journal-title":"J Clin Neurosci"},{"key":"e_1_2_13_4_1","doi-asserted-by":"crossref","first-page":"e1269","DOI":"10.1097\/CCM.0000000000006654","article-title":"Associations between prophylactic IV antibiotics and outcomes in patients with acute severe brain injury who require mechanical ventilation: Systematic review and meta\u2010analysis","volume":"53","author":"Ehrenzeller S","year":"2025","journal-title":"Crit Care Med"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010\u2010025\u201002709\u20103"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1016\/j.seizure.2014.04.012","article-title":"Infections in status epilepticus: a retrospective 5\u2010year cohort study","volume":"23","author":"Zelano J","year":"2014","journal-title":"Seizure"},{"issue":"53","key":"e_1_2_13_7_1","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1111\/j.1528-1167.2012.03576.x","article-title":"Associations between infections and clinical outcome parameters in status epilepticus: a retrospective 5\u2010year cohort study","volume":"19","author":"Sutter R","year":"2012","journal-title":"Epilepsia"},{"key":"e_1_2_13_8_1","doi-asserted-by":"crossref","first-page":"1779","DOI":"10.1097\/CCM.0000000000004642","article-title":"Frequency and implications of complications in the ICU after status epilepticus. No calm after the storm","volume":"48","author":"Baumann SM","year":"2020","journal-title":"Crit Care Med"},{"key":"e_1_2_13_9_1","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/0310057X0603400509","article-title":"Incidence of infections in patients with status epilepticus requiring intensive care and effect on resource utilization","volume":"34","author":"Ala\u2010Kokko TI","year":"2006","journal-title":"Anaesth Intensive Care"},{"key":"e_1_2_13_10_1","doi-asserted-by":"crossref","first-page":"3042","DOI":"10.1111\/epi.17100","article-title":"Prolonged mechanical ventilation in patients with terminated status epilepticus and outcome: an observational cohort study","volume":"62","author":"Baumann SM","year":"2021","journal-title":"Epilepsia"},{"key":"e_1_2_13_11_1","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The strengthening the reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"370","author":"Elm E","year":"2007","journal-title":"Lancet"},{"key":"e_1_2_13_12_1","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research electronic data capture (REDCap)\u2014a metadata\u2010driven methodology and workflow process for providing translational research informatics support","volume":"42","author":"Harris PA","year":"2009","journal-title":"J Biomed Inform"},{"key":"e_1_2_13_13_1","doi-asserted-by":"crossref","first-page":"1515","DOI":"10.1111\/epi.13121","article-title":"A definition and classification of status epilepticus\u2014report of the ILAE Task Force on Classification of Status Epilepticus","volume":"56","author":"Trinka E","year":"2015","journal-title":"Epilepsia"},{"key":"e_1_2_13_14_1","first-page":"1","article-title":"American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 version journal of clinical neurophysiology: official publication of the American Electroencephalographic","volume":"38","author":"Hirsch LJ","year":"2021","journal-title":"Society"},{"key":"e_1_2_13_15_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s12028-012-9695-z","article-title":"Guidelines for the evaluation and management of status epilepticus","volume":"17","author":"Brophy GM","year":"2012","journal-title":"Neurocrit Care"},{"key":"e_1_2_13_16_1","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/j.1528-1157.1993.tb00433.x","article-title":"Guidelines for epidemiologic studies on epilepsy","volume":"34","author":"Commission on Epidemiology and Prognosis ILAE","year":"1993","journal-title":"Epilepsia"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.2005.080887"},{"key":"e_1_2_13_18_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.resuscitation.2018.10.022","article-title":"Performance of clinical risk scores to predict mortality and neurological outcome in cardiac arrest patients","volume":"136","author":"Isenschmid C","year":"2018","journal-title":"Resuscitation"},{"key":"e_1_2_13_19_1","doi-asserted-by":"crossref","first-page":"1736","DOI":"10.1212\/01.wnl.0000223352.71621.97","article-title":"A clinical score for prognosis of status epilepticus in adults","volume":"66","author":"Rossetti AO","year":"2006","journal-title":"Neurology"},{"key":"e_1_2_13_20_1","doi-asserted-by":"crossref","first-page":"e475","DOI":"10.1097\/CCM.0b013e31829eca06","article-title":"Independent external validation of the status epilepticus severity score","volume":"41","author":"Sutter R","year":"2013","journal-title":"Crit Care Med"},{"key":"e_1_2_13_21_1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson ME","year":"1987","journal-title":"J Chronic Dis"},{"key":"e_1_2_13_22_1","doi-asserted-by":"crossref","first-page":"48","DOI":"10.5698\/1535-7597-16.1.48","article-title":"Evidence\u2010based guideline: treatment of convulsive status epilepticus in children and adults: report of the guideline committee of the American Epilepsy Society","volume":"16","author":"Glauser T","year":"2016","journal-title":"Epilepsy Curr"},{"key":"e_1_2_13_23_1","doi-asserted-by":"crossref","first-page":"10597","DOI":"10.1523\/JNEUROSCI.3440-07.2007","article-title":"Hypersensitivity of the anesthesia\u2010induced comatose brain","volume":"27","author":"Kroeger D","year":"2007","journal-title":"J Neurosci"},{"key":"e_1_2_13_24_1","doi-asserted-by":"crossref","first-page":"e1955","DOI":"10.1212\/WNL.0000000000207129","article-title":"Association between induced burst\u2010suppression and clinical outcomes in patients with refractory status epilepticus: a 9\u2010year cohort study","volume":"100","author":"Fisch U","year":"2023","journal-title":"Neurology"},{"key":"e_1_2_13_25_1","doi-asserted-by":"crossref","DOI":"10.1212\/WNL.0000000000207995","article-title":"Association between dose escalation of anesthetics and outcomes in patients with refractory status epilepticus","volume":"102","author":"Fisch U","year":"2024","journal-title":"Neurology"},{"issue":"263","key":"e_1_2_13_26_1","doi-asserted-by":"crossref","first-page":"1303","DOI":"10.1007\/s00415-016-8140-1","article-title":"Independent impact of infections on the course and outcome of status epilepticus: a 10\u2010year cohort study","volume":"3","author":"Semmlack S","year":"2016","journal-title":"J Neurol"},{"key":"e_1_2_13_27_1","unstructured":"Centers for Disease Control and Prevention.2024 National Healthcare Safety Network (NHSN) Patient Safety Component Manual.2024."},{"key":"e_1_2_13_28_1","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1164\/rccm.201908-1581ST","article-title":"Diagnosis and treatment of adults with community\u2010acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America","volume":"200","author":"Metlay JP","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"e_1_2_13_29_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.332.7554.1355","article-title":"Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate\u2010severe community acquired pneumonia: randomised, double blind study","volume":"332","author":"Moussaoui R","year":"2006","journal-title":"BMJ"},{"key":"e_1_2_13_30_1","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1093\/cid\/ciw353","article-title":"Management of adults with hospital\u2010acquired and ventilator\u2010associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society","volume":"63","author":"Kalil AC","year":"2016","journal-title":"Clin Infect Dis"},{"key":"e_1_2_13_31_1","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00582-2017","article-title":"International ERS\/ESICM\/ESCMID\/ALAT guidelines for the management of hospital\u2010acquired pneumonia and ventilator\u2010associated pneumonia: guidelines for the management of hospital\u2010acquired pneumonia (HAP)\/ventilator\u2010associated pneumonia (VAP) of the European Respiratory Society (ERS), European Society of Intensive Care Medicine (ESICM), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Asociacion Latinoamericana del Torax (ALAT)","volume":"50","author":"Torres A","year":"2017","journal-title":"Eur Respir J"},{"key":"e_1_2_13_32_1","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1093\/cid\/ciac809","article-title":"Less is more: a 7\u2010day course of antibiotics is the evidence\u2010based treatment for Pseudomonas aeruginosa ventilator\u2010associated pneumonia","volume":"76","author":"Metersky ML","year":"2023","journal-title":"Clin Infect Dis"},{"key":"e_1_2_13_33_1","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1038\/nrneurol.2013.154","article-title":"Outcome predictors for status epilepticus\u2014what really counts","volume":"9","author":"Sutter R","year":"2013","journal-title":"Nat Rev Neurol"},{"key":"e_1_2_13_34_1","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10309-012-0281-3","article-title":"Predicting outcome in adults with status epilepticus","volume":"26","author":"Sutter R","year":"2013","journal-title":"Z Epileptol"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm11226673"},{"key":"e_1_2_13_36_1","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2377-11-110","article-title":"Post\u2010stroke infection: a systematic review and meta\u2010analysis","volume":"11","author":"Westendorp WF","year":"2011","journal-title":"BMC Neurol"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2010.178"},{"key":"e_1_2_13_38_1","doi-asserted-by":"crossref","DOI":"10.1016\/j.clineuro.2024.108554","article-title":"Complications during and after ICU stay are associated with increased mortality after status epilepticus","volume":"246","author":"Damien C","year":"2024","journal-title":"Clin Neurol Neurosurg"},{"key":"e_1_2_13_39_1","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1212\/WNL.0000000000002023","article-title":"Seizures as adverse events of antibiotic drugs: a systematic review","volume":"85","author":"Sutter R","year":"2015","journal-title":"Neurology"},{"key":"e_1_2_13_40_1","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.seizure.2020.08.012","article-title":"Antibiotic\u2010induced epileptic seizures: mechanisms of action and clinical considerations","volume":"81","author":"Wanleenuwat P","year":"2020","journal-title":"Seizure"},{"key":"e_1_2_13_41_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s10072-012-1001-5","article-title":"Association of antibiotics with status epilepticus","volume":"34","author":"Misra UK","year":"2013","journal-title":"Neurol Sci"},{"issue":"380","key":"e_1_2_13_42_1","doi-asserted-by":"crossref","first-page":"651","DOI":"10.1056\/NEJMra1714562","article-title":"Aspiration Pneumonia","volume":"14","author":"Mandell LA","year":"2019","journal-title":"N Engl J Med"},{"issue":"12","key":"e_1_2_13_43_1","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1038\/nrneurol.2016.45","article-title":"Nonconvulsive status epilepticus in adults\u2014insights into the invisible","volume":"11","author":"Sutter R","year":"2016","journal-title":"Nat Rev Neurol"}],"container-title":["Epilepsia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70458","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/epi.70458","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/epi.70458","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:13:40Z","timestamp":1789661620000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/epi.70458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,17]]},"references-count":42,"alternative-id":["10.1002\/epi.70458"],"URL":"https:\/\/doi.org\/10.1002\/epi.70458","archive":["Portico"],"relation":{},"ISSN":["0013-9580","1528-1167"],"issn-type":[{"value":"0013-9580","type":"print"},{"value":"1528-1167","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,17]]},"assertion":[{"value":"2026-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-05","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-17","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"epi.70458"}}