Association of nosocomial infections with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage

Paul M. Foreman, Michelle Chua, Mark R. Harrigan, Winfield S. Fisher, Nilesh A. Vyas, Robert H. Lipsky, Beverly C. Walters, R. Shane Tubbs, Mohammadali Mohajel Shoja, Christoph J. Griessenauer

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26 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1383-1389
Number of pages7
JournalJournal of Neurosurgery
Volume125
Issue number6
DOIs
StatePublished - Dec 1 2016
Externally publishedYes

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Keywords

  • Aneurysm
  • Delayed cerebral ischemia
  • Infection
  • Subarachnoid hemorrhage
  • Vascular disorders
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Foreman, P. M., Chua, M., Harrigan, M. R., Fisher, W. S., Vyas, N. A., Lipsky, R. H., Walters, B. C., Tubbs, R. S., Mohajel Shoja, M., & Griessenauer, C. J. (2016). Association of nosocomial infections with delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage. Journal of Neurosurgery, 125(6), 1383-1389. https://doi.org/10.3171/2015.10.JNS151959