Bacteremia Associated With Delayed Cerebral Ischemia After Interventional Treatment of Aneurysmal Subarachnoid Hemorrhage

Objective Delayed cerebral ischemia (DCI) after aneurysmal subarachnoid hemorrhage (aSAH) is a major cause of poor neurological outcomes. Although systemic inflammation related to nosocomial infection has been suggested to contribute to DCI, the specific role of bacteremia remains unclear. This study aimed to evaluate the association between nosocomial infection, particularly bacteremia, and the development of DCI in patients with aSAH treated with coil embolization. Methods We retrospectively reviewed patients with aSAH treated at our institution between April 2016 and July 2019. After applying predefined exclusion criteria, including early death due to primary brain injury and insufficient postoperative evaluation, 59 patients who underwent coil embolization were included. Patients were divided into two groups according to the occurrence of DCI. Clinical characteristics, infection-related variables, and outcomes were compared. Univariate analyses were performed, followed by multivariate logistic regression analysis to identify factors associated with DCI. Results DCI developed in nine of 59 patients (15%). In univariate analysis, angiographic vasospasm and nosocomial infection were significantly associated with DCI. In multivariate logistic regression analysis, bacteremia was independently associated with the development of DCI (odds ratio, 39.22; 95% confidence interval, 2.25-684.45; P = 0.01). Conclusions Bacteremia was independently associated with the development of DCI in patients with aSAH treated with coil embolization. Although causality cannot be established due to the retrospective design and limited sample size, these findings suggest that systemic infection characterized by bacteremia may be clinically relevant to the pathophysiology of DCI. Further prospective studies are warranted to clarify this association.