Subarachnoid hemorrhage (SAH) is associated with high morbidity. Among all complications, infections, in particular if hospital-acquired, could represent an important cause of death in SAH patients. The aim of this study was to describe infectious complications in SAH patients and to evaluate their impact on outcome.
Single-center cohort study including all SAH patients admitted from January 2011 to December 2016, who stayed in the ICU for at least 24 hours. Infection diagnosis was retrieved from medical files; central nervous system infections were not included. A multivariable analysis was performed to identify risk factors for development of infection. Logistic regression was performed to identify risks for unfavorable neurological outcome at 3 months, defined as a Glasgow Outcome Scale of 1-3.
Of the 248 SAH patients, 70 (28.2%) developed at least one infection; the most frequent site of infection was respiratory (57.1%), primary bloodstream (16%) and urinary tract infections (15.7%). Twenty-eight patients (11.3 % of all patients) had at least one episode of septic shock. Infected patients had a higher UO rate (60.0% vs. 33.3%, p=0.001). Diabetes mellitus [SHR 1.79 (CI 95% 1.03-3.13)] and Intracranial hypertension [SHR 1.92 (CI 95% 1.14-3.25)] were independently associated with the occurrence of infections. Septic shock [OR 6.36 (CI 95% 1.24-32.51), p=0.02 ] was independently associated with unfavorable outcome.
Infections in SAH patients are prevalent, especially pneumonia. Septic shock is associated with a poor neurological outcome in this group of patients.

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