Fever Burden in Patients With Subarachnoid Hemorrhage and the Increased Use of Antibiotics

• Published in: Journal of stroke and cerebrovascular diseases 2019-11, Vol.28 (11), p.104313-104313, Article 104313
• Main Authors: Magee, Carolyn A., Thompson Bastin, Melissa L., Graves, Katelyn, Burgess, Donna, Nestor, Melissa, Lamm, John R., Cook, Aaron M.
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - therapeutic use; antibiotics; Antimicrobial Stewardship; Body Temperature Regulation - drug effects; Female; Fever; Fever - drug therapy; Fever - microbiology; Fever - physiopathology; fever burden; Humans; Inappropriate Prescribing; Length of Stay; Male; Middle Aged; Retrospective Studies; Risk Assessment; Risk Factors; subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Time Factors; Treatment Outcome
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2019.104313

Background: Fever occurs in the majority of subarachnoid hemorrhage (SAH) patients. Nearly 50% of SAH patients have noninfectious fevers. Data are lacking describing the effects of fever burden in the SAH patient population. Methods: This was a single-center, retrospective observational cohort study in patients more or equal to 18 years of age with a diagnosis of nontraumatic SAH admitted to an ICU between January 1, 2010 and September 1, 2015. Exclusion criteria were SAH secondary to trauma or admission for more than 48 hours. Temperature measurements, demographic data, and other pertinent information were collected from Day 0 to Day 13. Daily fever burden was calculated for each patient by calculating an area under the curve. Results: A total of 194 subjects were included. The mean study period maximum temperature (Tmax) for all 194 patients was 40.8 ± 0.83°C. The mean overall fever burden for all 194 patients was 89.2 ± 99.59°C h more than 37°C. The overall fever burden peaked on day 5 and declined thereafter. Fever burden, Tmax, and length of stay in the hospital were all significantly associated with receipt of antibiotics. Only Tmax was associated with poor outcome. The 31 patients who had fever but no identified cause of infection received 1000 doses of antibiotics or 32.25 doses per patient. Conclusion: Fever is common in SAH patients and is associated with antibiotic use, infection, vasospasm, and poor outcome. Some SAH patients may receive antibiotics unnecessarily for noninfectious fever. Clinicians should consider using site-specific parameters related to infection rather than systemic symptoms such as fever to evaluate infection in SAH patients.