Nosocomial Infections and Antimicrobial Treatment in Coiled Patients with Aneurysmal Subarachnoid Hemorrhage

Title:Nosocomial Infections and Antimicrobial Treatment in Coiled Patients with Aneurysmal Subarachnoid Hemorrhage

Volume: 18 Issue: 12

Author(s): Peter Lackner*, Christoph Mueller, Ronny Beer, Gregor Broessner, Marlene Fischer, Raimund Helbok, Alois Schiefecker, Erich Schmutzhard and Bettina Pfausler

Affiliation:

• Department of Neurology, Medical University of Innsbruck, Anichstrasse 35 6020, Innsbruck,Austria

Keywords: Inflammation, outcome, infection, C-reactive protein, subarachnoid hemorrhage, neurohemoinflammation.

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>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.

Conclusion: 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.

Cite this article as:

Lackner Peter*, Mueller Christoph, Beer Ronny, Broessner Gregor, Fischer Marlene, Helbok Raimund, Schiefecker Alois, Schmutzhard Erich and Pfausler Bettina, Nosocomial Infections and Antimicrobial Treatment in Coiled Patients with Aneurysmal Subarachnoid Hemorrhage, Current Drug Targets 2017; 18 (12) . https://dx.doi.org/10.2174/1389450117666160401124426

DOI https://dx.doi.org/10.2174/1389450117666160401124426	Print ISSN 1389-4501
Publisher Name Bentham Science Publisher	Online ISSN 1873-5592