title: Association of nosocomial infections with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE Delayed cerebral ischemia (DCI) is a recognized complication of aneurysmal subarachnoid hemorrhage (aSAH) that contributes to poor outcome. This study seeks to determine the effect of nosocomial infection on the incidence of DCI and patient outcome. METHODS An exploratory analysis was performed on 156 patients with aSAH enrolled in the Cerebral Aneurysm Renin Angiotensin System study. Clinical and radiographic data were analyzed with univariate analysis to detect risk factors for the development of DCI and poor outcome. Multivariate logistic regression was performed to identify independent predictors of DCI. RESULTS One hundred fifty-three patients with aSAH were included. DCI was identified in 32 patients (20.9%). Nosocomial infection (odds ratio [OR] 3.5, 95% confidence interval [CI] 1.09-11.2, p = 0.04), ventriculitis (OR 25.3, 95% CI 1.39-458.7, p = 0.03), aneurysm re-rupture (OR 7.55, 95% CI 1.02-55.7, p = 0.05), and clinical vasospasm (OR 43.4, 95% CI 13.1-143.4, p < 0.01) were independently associated with the development of DCI. Diagnosis of nosocomial infection preceded the diagnosis of DCI in 15 (71.4%) of 21 patients. Patients diagnosed with nosocomial infection experienced significantly worse outcomes as measured by the modified Rankin Scale score at discharge and 1 year (p < 0.01 and p = 0.03, respectively). CONCLUSIONS Nosocomial infection is independently associated with DCI. This association is hypothesized to be partly causative through the exacerbation of systemic inflammation leading to thrombosis and subsequent ischemia.
authors: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors: Paul M
authors: PM
authors: Foreman
authors: Harvard Medical School, Harvard University, Boston, Massachusetts.
authors: Michelle
authors: M
authors: Chua
authors: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors: Mark R
authors: MR
authors: Harrigan
authors: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.
authors: Winfield S
authors: WS
authors: Fisher
authors: Department of Neurosciences, INOVA Health System, Fairfax, Virginia.
authors: Nilesh A
authors: NA
authors: Vyas
authors: Department of Neurosciences, INOVA Health System, Fairfax, Virginia.
authors: Robert H
authors: RH
authors: Lipsky
authors: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.|Department of Neurosciences, INOVA Health System, Fairfax, Virginia.
authors: Beverly C
authors: BC
authors: Walters
authors: Children's of Alabama, Birmingham, Alabama; and.
authors: R Shane
authors: RS
authors: Tubbs
authors: Children's of Alabama, Birmingham, Alabama; and.
authors: Mohammadali M
authors: MM
authors: Shoja
authors: Department of Neurosurgery, University of Alabama at Birmingham, Alabama.|Beth Israel Deaconess Medical Center, Division of Neurosurgery, Harvard University, Boston, Massachusetts.
authors: Christoph J
authors: CJ
authors: Griessenauer
mesh_terms: D002545:Brain Ischemia / Q000453:epidemiology* / Q000209:etiology*; D003428:Cross Infection / Q000150:complications*; D005260:Female; D006801:Humans; D015994:Incidence; D002532:Intracranial Aneurysm / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D013997:Time Factors
keywords: BAL = bronchoalveolar lavage; CARAS = Cerebral Aneurysm Renin Angiotensin System; CI = confidence interval; CTA = CT angiography; DCI = delayed cerebral ischemia; DSA = digital subtraction angiography; EVD = external ventricular drain; GCS = Glasgow Coma Scale; ICU = intensive care unit; OR = odds ratio; TCD = transcranial Doppler ultrasonography; UTI = urinary tract infection; aSAH = aneurysmal subarachnoid hemorrhage; aneurysm; delayed cerebral ischemia; infection; mRS = modified Rankin Scale; subarachnoid hemorrhage; vascular disorders; vasospasm