title: Preventive Antibiotics and Delayed Cerebral Ischaemia in Patients with Aneurysmal Subarachnoid Haemorrhage Admitted to the Intensive Care Unit.
abstract: BACKGROUND
  Delayed cerebral ischemia (DCI) is an important contributor to poor outcome after aneurysmal subarachnoid haemorrhage (aSAH). Development of DCI is multifactorial, and inflammation, with or without infection, is one of the factors independently associated with development of DCI and poor outcome. We thus postulated that preventive antibiotics might be associated with a reduced risk of DCI and subsequent poor outcome in aSAH patients.
  
  
  METHODS
  We performed a retrospective cohort-study in intensive care units (ICU) of three university hospitals in The Netherlands. We included consecutive aSAH patients with minimal ICU stay of 72 h who received either preventive antibiotics (SDD: selective digestive tract decontamination including systemic cefotaxime or SOD: selective oropharyngeal decontamination) or no preventive antibiotics. DCI was defined as a new hypodensity on CT with no other explanation than DCI. Hazard ratio's (HR) for DCI and risk ratio's (RR) for 28-day case-fatality and poor outcome at 3 months were calculated, with adjustment (aHR/aRR) for clinical condition on admission, recurrent bleeding, aneurysm treatment modality and treatment site.
  
  
  RESULTS
  Of 459 included patients, 274 received preventive antibiotics (SOD or SDD) and 185 did not. With preventive antibiotics, the aHR for DCI was 1.0 (95% CI 0.6-1.8), the aRR for 28-day case-fatality was 1.1 (95% CI 0.7-1.9) and the aRR for poor functional outcome 1.2 (95% CI 1.0-1.4).
  
  
  CONCLUSIONS
  Preventive antibiotics were not associated with reduced risk of DCI or poor outcome in aSAH patients in the ICU.
authors.affiliation: Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands. c.s.gathier-2@umcutrecht.nl.|Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room F.06.134, PO Box 85500, 3508 GA, Utrecht, The Netherlands. c.s.gathier-2@umcutrecht.nl.
authors.forename: Celine S
authors.initials: CS
authors.lastname: Gathier
authors.affiliation: Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands.|Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Evelien A
authors.initials: EA
authors.lastname: Oostdijk
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room F.06.134, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Gabriel J E
authors.initials: GJ
authors.lastname: Rinkel
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room F.06.134, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Sanne M
authors.initials: SM
authors.lastname: Dorhout Mees
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room F.06.134, PO Box 85500, 3508 GA, Utrecht, The Netherlands.
authors.forename: Mervyn D I
authors.initials: MD
authors.lastname: Vergouwen
authors.affiliation: Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Anne Marie G A
authors.initials: AM
authors.lastname: de Smet
authors.affiliation: Department of Neurology, Center of Infection and Immunity Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.affiliation: Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: W Peter
authors.initials: WP
authors.lastname: Vandertop
authors.affiliation: Department of Neurosurgery, Neurosurgical Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Verbaan
authors.affiliation: Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Room F.06.134, PO Box 85500, 3508 GA, Utrecht, The Netherlands.|Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: Marc J M
authors.initials: MJ
authors.lastname: Bonten
authors.affiliation: Department of Critical Care, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Walter M
authors.initials: WM
authors.lastname: van den Bergh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000494:pharmacology*; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000209:etiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Aneurysmal subarachnoid haemorrhage; Antibiotics; Case–control study; Delayed cerebral ischaemia; Intensive care unit