title: Hospital-Acquired Infections after Aneurysmal Subarachnoid Hemorrhage: A Nationwide Analysis.
abstract: BACKGROUND
  This is the first nationwide study to evaluate the factors associated with developing hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH) and analyze their impact on the efficiency of hospital care.
  
  
  METHODS
  Data from patients with SAH who underwent aneurysm repair were extracted from the Nationwide Inpatient Sample (2008-2011). Urinary tract infections, pneumonia, central venous catheter (CVC)-associated blood stream infection, and meningitis/ventriculitis were evaluated. Independent predictors of HAIs used in multivariable logistic regression modeling were chosen using forward selection; hierarchical multivariable linear regression assessed length of stay and charges.
  
  
  RESULTS
  Seven thousand five hundred sixteen admissions were included. Independent predictors in the logistic regression for developing a urinary tract infection (23.9%) included older age, female sex, noninfectious complications (P < 0.001), intracerebral hemorrhage (P = 0.009), and diabetes with complications (P = 0.04). Pneumonia (23.0%) was associated with older age (P = 0.003), congestive heart failure, severity of SAH, and noninfectious complications (P < 0.001). Severity of SAH and noninfectious complications were predictors of meningitis/ventriculitis (4.4%; P ≤ 0.02), whereas intracerebral hemorrhage and noninfectious complications were predictors of CVC-associated infections (1.0%; P ≤ 0.02). All HAIs were associated with significantly longer hospitalizations and higher charges. Pneumonia (odds ratio [OR], 2.85; 95% confidence interval (CI), 2.44-3.34) and CVC-associated infections (OR, 2.42; 95% CI, 1.26-4.66) were also independently associated with greater odds of poor outcome (death or institutional care).
  
  
  CONCLUSIONS
  In this nationwide analysis, urinary tract infections and pneumonia were the most common hospital-acquired infections after SAH. Although all infections were associated with significantly longer hospitalizations and greater charges, pneumonia and CVC-associated infections were also associated with increased likelihood of a poor outcome.
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Hormuzdiyar H
authors.initials: HH
authors.lastname: Dasenbrock
authors.affiliation: Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Rudy
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Donovan
authors.initials: D
authors.lastname: Guttieres
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: Kai U
authors.initials: KU
authors.lastname: Frerichs
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: William B
authors.initials: WB
authors.lastname: Gormley
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: M Ali
authors.initials: MA
authors.lastname: Aziz-Sultan
authors.affiliation: Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA. Electronic address: rdu@partners.org.
authors.forename: Rose
authors.initials: R
authors.lastname: Du
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D003428:Cross Infection / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018410:Pneumonia, Bacterial / Q000401:mortality*; D011379:Prognosis; D012307:Risk Factors; D017678:Sex Distribution; D013345:Subarachnoid Hemorrhage / Q000401:mortality* / Q000601:surgery*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000401:mortality*; D055815:Young Adult
keywords: Cerebral aneurysm; Hospital-acquired infection; Meningitis; National Surgical Quality Improvement Program; Nationwide Inpatient Sample; Pneumonia; Subarachnoid hemorrhage; Urinary tract infection