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.