Hospital-Acquired Infections after Aneurysmal Subarachnoid Hemorrhage: A Nationwide Analysis

• Published in: World neurosurgery 2016-04, Vol.88, p.459-474
• Main Authors: Dasenbrock, Hormuzdiyar H, Rudy, Robert F, Smith, Timothy R, Guttieres, Donovan, Frerichs, Kai U, Gormley, William B, Aziz-Sultan, M. Ali, Du, Rose
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Age Distribution; Aged; Cerebral aneurysm; Cross Infection - mortality; Female; Hospital Mortality; Hospital-acquired infection; Humans; Incidence; Length of Stay; Male; Meningitis; Middle Aged; National Surgical Quality Improvement Program; Nationwide Inpatient Sample; Neurosurgery; Pneumonia; Pneumonia, Bacterial - mortality; Prognosis; Risk Factors; Sex Distribution; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - mortality; Subarachnoid Hemorrhage - surgery; Survival Rate; United States - epidemiology; Urinary tract infection; Urinary Tract Infections - mortality; Young Adult
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2015.10.054

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). Conclusion 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.