Brazilian study reveals that specialized ICUs offer more effective treatments for serious neurological infections in the Country 

A study published in the Journal of Intensive Care Medicine investigated the effectiveness of specialized intensive care units (ICUs) focused on infectious diseases in treating severe central nervous system infections. Conducted by the Oswaldo Cruz Foundation (Fiocruz) in collaboration with the D’Or Institute for Research and Education (IDOR), Fluminense Federal University (UFF), and other research institutions, the study compared specialized ICUs to general ICUs in Brazil, offering new insights into the role of specialization in managing complex infections. 

Differences across ICU types
Intensive care units are critical for treating seriously ill patients. However, not all ICUs are the same. While general ICUs treat a broad range of conditions, specialized ICUs focus on specific areas like cardiology, neurology, or infectious diseases. Specialization allows healthcare teams to develop deeper expertise and adopt tailored protocols. 

Studying differences in ICU types helps identify which approaches yield better outcomes—especially for severe neurological infections, which demand precise and complex interventions. 

How were outcomes measured?
To assess efficiency, researchers analyzed data from 785 admissions and 82 CNS infection cases at the National Institute of Infectious Diseases Evandro Chagas (INI/Fiocruz), from January 2012 to January 2019. 

For comparison, the study used data from 303,500 ICU admissions across Brazil’s public health system (SUS), collected through the “Brazilian ICUs” project by Epimed Solutions, which gathers data from over 1,000 ICUs nationwide. 

Clinical, epidemiological, and performance indicators were analyzed. Two key metrics were: Standardized Mortality Ratio (SMR) and Standardized Resource Use per Survivor (SRU). The interpretation reads: 

• 1.0 = expected outcome 

• >1.0 = higher-than-expected mortality or resource use (negative) 

• <1.0 = better-than-expected outcome (positive) 

Results and efficiency
Infections were the leading diagnosis in both SUS mixed ICUs (18.2%) and INI (49.6%). At INI, 11% of cases involved CNS infections—the second most frequent diagnosis. Despite high severity, outcomes were relatively favorable at INI, likely due to specialized management. 

INI’s ICU patients were generally more severe, often with HIV/AIDS—a population more vulnerable to serious infections like sepsis, requiring interventions such as dialysis, vasopressors, and mechanical ventilation. 

INI’s overall SMR was 1.1 and SRU was 1.1—within expected values. Specifically for CNS infections, SMR was 0.95 and SRU 1.01, suggesting slightly better performance than SUS’s mixed and neurological ICUs. 

Mixed SUS ICUs had SMR of 1.26 and SRU of 1.59; neurological SUS ICUs reported 1.17 and 2.23, respectively. These findings suggest that infectious disease-focused ICUs may offer more efficient and effective treatment for severe neurological infections. 

Expanding specialized ICUs: a step forward for critical care
The study underscores how specialization—like that seen at INI—can lead to better outcomes for complex infections. Expanding access to such units in high-risk areas could improve critical care and patient survival. Further research is needed to confirm these findings and support health policy decisions on ICU resource allocation. 

Written by Maria Eduarda Ledo de Abreu.