Impact of nosocomial infectious complications after subarachnoid hemorrhage.
OBJECTIVE
Critically ill neurological patients are susceptible to infections that may be distinct from other intensive care patients. The aim of this study is to quantify the prevalence, risk factors, and effect on the outcome of nosocomial infectious complications in patients with subarachnoid hemorrhage (SAH).


METHODS
We studied 573 consecutive patients with SAH, identified the most prevalent infectious complications, and performed univariate analyses to determine risk factors for each complication. Multiple logistic regression models were constructed to calculate adjusted odds ratios for associated risk factors and to assess the impact of infectious complications on 3-month outcome as evaluated with the modified Rankin Scale.


RESULTS
The most prevalent nosocomial infections were pneumonia (n = 114, 20%), urinary tract infection (n = 77, 13%), bloodstream infection (BSI) (n = 48, 8%), and meningitis/ventriculitis (n = 28, 5%). Significant independent associations with pneumonia included older age, poor Hunt and Hess grade, intubation/mechanical ventilation, and loss of consciousness at ictus. Urinary tract infection was associated with female sex and central line use. BSI was also associated with central line use, and meningitis/ventriculitis was associated with the presence of intraventricular hemorrhage and external ventricular drainage (all P < 0.05). After adjustment for Hunt and Hess grade, aneurysm size, and age, pneumonia (adjusted odds ratio, 2.04; 95% confidence interval, 1.12-3.71; P = 0.020) and BSI (adjusted odds ratio, 2.51; 95% confidence interval, 1.14-5.56; P = 0.023) independently predicted death or severe disability at 3 months. Prolonged length of stay was significantly associated with all infection types (P < 0.001).


CONCLUSIONS
Pneumonia and BSI are common infectious complications of SAH and independently predict poor outcome. The implementation of infection-control measures may be needed to improve outcome after SAH.
Frontera
Jennifer A
JA
Department of Neurosurgery, Mount Sinai School of Medicine, New York, New York 10029, USA. Jennifer.Frontera@mountsinai.org
Fernandez
Andres
A
Schmidt
J Michael
JM
Claassen
Jan
J
Wartenberg
Katja E
KE
Badjatia
Neeraj
N
Parra
Augusto
A
Connolly
E Sander
ES
Mayer
Stephan A
SA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003141:Communicable Diseases / Q000145:classification / Q000150:complications / Q000453:epidemiology; D003428:Cross Infection / Q000145:classification* / Q000150:complications* / Q000453:epidemiology* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D016017:Odds Ratio; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000453:epidemiology*