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

## TL;DR

Bacteremia, a type of blood infection, is linked to delayed brain problems in patients treated for a specific type of brain hemorrhage.

## Contribution

This study identifies bacteremia as an independent risk factor for delayed cerebral ischemia after coil embolization for aneurysmal subarachnoid hemorrhage.

## Key findings

- DCI occurred in 15% of patients with aSAH treated with coil embolization.
- Bacteremia was independently associated with DCI development (odds ratio 39.22).
- Nosocomial infection and angiographic vasospasm were significantly linked to DCI in univariate analysis.

## Abstract

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.