title: Nosocomial Infections and Antimicrobial Treatment in Coiled Patients with Aneurysmal Subarachnoid Hemorrhage.
abstract: BACKGROUND
  Nosocomial infections are common in patients with spontaneous subarachnoid hemorrhage (SAH). The aim of this retrospective cohort study was to determine the incidence of infections during SAH and to evaluate the course of inflammation parameters and its implications for long term outcome.
  
  
  OBJECTIVE
  Ninety-nine consecutive coiled SAH patients were included. Laboratory and clinical parameters as well as culture positive infections were followed over the disease course. Long-term outcome was assessed at 6-month by the Glasgow Outcome score (GOS) and dichotomized in favorable (GOS&gt;3) and unfavorable outcome (GOS≤3).
  
  
  RESULTS
  The most frequent infections were pulmonary (30.3%) urinary tract (25.3%), blood stream infections (20.2%) and ventriculitis (5.1%). The incidence of infections did not significantly differ between outcome groups. In contrast, patients with unfavorable outcome had a higher incidence of sepsis (46.7% versus 24.6%). C-reactive protein (CRP) and leukocytes were significantly higher in patients with unfavorable outcome. A CRP increase of 6 mg/dl or more in the first 3 days after SAH was independently associated with unfavorable outcome (OR 7.19 CI 1.7-30.52; p=0.008). Patients with an early CRP increase were more frequently treated with antimicrobial therapy in the first 3 days after admission which led to a significantly lower incidence of culture positive infections in the later course.
  
  
  CONCLUSIONS
  A sharp CRP-increase in the acute phase of SAH could potentially aid the intensivist in the early identification of patients at high risk for neurological morbidity. Early antimicrobial treatment reduces the rate of patients showing culture positive infections in the course of the disease.
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Peter
authors.initials: P
authors.lastname: Lackner
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Mueller
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Ronny
authors.initials: R
authors.lastname: Beer
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Gregor
authors.initials: G
authors.lastname: Broessner
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Marlene
authors.initials: M
authors.lastname: Fischer
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Raimund
authors.initials: R
authors.lastname: Helbok
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Alois
authors.initials: A
authors.lastname: Schiefecker
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Erich
authors.initials: E
authors.lastname: Schmutzhard
authors.affiliation: Department of Neurology, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfausler
mesh_terms: D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D002097:C-Reactive Protein / Q000378:metabolism*; D058565:Cerebral Ventriculitis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D003428:Cross Infection / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D007958:Leukocyte Count; D008171:Lung Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018805:Sepsis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D013345:Subarachnoid Hemorrhage / Q000378:metabolism* / Q000382:microbiology*; D016896:Treatment Outcome; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology
chemical_list: D000890:Anti-Infective Agents; D002097:C-Reactive Protein
keywords: C-reactive protein; Inflammation; infection; neurohemoinflammation; outcome; subarachnoid hemorrhage