Etiologic Diagnosis and Clinical Treatment of Multiple Drug-Resistant Bacteria Infection in Elderly Patients with Stroke-Associated Pneumonia After Neurosurgery

Liu, Yan; Ye, Qing; Jin, Xiaobin; Qiao, Hui

doi:10.1007/s12013-014-0256-2

Cited by 8 publications

(9 citation statements)

References 26 publications

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“…The oral flora change rapidly after stroke and colonization by Gram-negative bacteria occurs more frequently than in non-stroke patients [61]. Different bacterial species have been isolated from the sputum of stroke patients, including Streptococcus pneumoniae , Staphylococcus aureus , Klebsiella pneumoniae , Pseudomonas aeruginosa, Escherichia coli and Enterobacter cloacae [62]. Even though E. coli has been found in more than 95% of blood and lung cultures obtained from mice post stroke [18], the causative agent of infection cannot be identified in a large portion of patients post stroke [52].…”

Section: Systemic Immunosuppressionmentioning

confidence: 99%

Immunomodulation after ischemic stroke: potential mechanisms and implications for therapy

et al. 2016

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Brain injuries are often associated with intensive care admissions, and carry high morbidity and mortality rates. Ischemic stroke is one of the most frequent causes of injury to the central nervous system. It is now increasingly clear that human stroke causes multi-organ systemic disease. Brain inflammation may lead to opposing local and systemic effects. Suppression of systemic immunity by the nervous system could protect the brain from additional inflammatory damage; however, it may increase the susceptibility to infection. Pneumonia and urinary tract infection are the most common complications occurring in patients after stroke. The mechanisms involved in lung-brain interactions are still unknown, but some studies have suggested that inhibition of the cholinergic anti-inflammatory pathway and release of glucocorticoids, catecholamines, and damage-associated molecular patterns (DAMPs) are among the pathophysiological mechanisms involved in communication from the ischemic brain to the lungs after stroke. This review describes the modifications in local and systemic immunity that occur after stroke, outlines mechanisms of stroke-induced immunosuppression and their role in pneumonia, and highlights potential therapeutic targets to reduce post-stroke complications. Despite significant advances towards a better understanding of the pathophysiology of ischemic stroke-induced immunosuppression and stroke-associated pneumonia (SAP) in recent years, many unanswered questions remain. The true incidence and outcomes of SAP, especially in intensive care unit settings, have yet to be determined, as has the full extent of stroke-induced immunosuppression and its clinical implications.

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Section: Systemic Immunosuppressionmentioning

confidence: 99%

Immunomodulation after ischemic stroke: potential mechanisms and implications for therapy

et al. 2016

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“…While infections are common after stroke, the causative agent remains elusive and may be contributed by a number of pathogens. Types of bacteria that have been commonly found in the sputum and urine of stroke patients include Streptococcus pneumoniae , Staphylococcus aureus , Klebsiella pneumoniae and Psuedomonas aeruginosa [ 109 ]. Surprisingly, reports of common gut bacteria have been reported with Escherichia coli and Enterobacter cloacae being two of the most frequently detected [ 110 ].…”

Section: Other Causes Of Infection After Strokementioning

confidence: 99%

“…Lastly, another possible reason that antibiotic treatment is not effective is the unsuitable use of particular antibiotics due to antibiotic resistant bacteria. One study took sputum samples from patients with stroke-associated pneumonia, cultured for bacteria and tested their drug sensitivity against a range common antibiotics including penicillin, tetracycline, ceftriaxone and moxifloxacin [ 109 ]. The prevalent strains of bacteria that were found in the sputum were Psuedomonas aeruginosa (23.92%), Staphylococcus aureus (15.32%) and Escherichia coli (14.25%).…”

Section: Treatments For Stroke-associated Infectionsmentioning

confidence: 99%

“…The prevalent strains of bacteria that were found in the sputum were Psuedomonas aeruginosa (23.92%), Staphylococcus aureus (15.32%) and Escherichia coli (14.25%). The study found that drug resistance against moxifloxacin, used in the PANTHERIS trial [ 108 ], was 52.63% in S. aureus [ 109 ]. Strikingly, resistance rates against ceftriaxone, the antibiotic of choice used in the PASS trial [ 107 ], was 100% for both Escherichia coli and Psuedomonas aeruginosa [ 109 ] which may offer an explanation to why pneumonia was not reduced in ceftriaxone-treated stroke patients.…”

Section: Treatments For Stroke-associated Infectionsmentioning

confidence: 99%

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Ischemia, Immunosuppression and Infection—Tackling the Predicaments of Post-Stroke Complications

Shim

Wong

2016

IJMS

144

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The incidence of stroke has risen over the past decade and will continue to be one of the leading causes of death and disability worldwide. While a large portion of immediate death following stroke is due to cerebral infarction and neurological complications, the most common medical complication in stroke patients is infection. In fact, infections, such as pneumonia and urinary tract infections, greatly worsen the clinical outcome of stroke patients. Recent evidence suggests that the disrupted interplay between the central nervous system and immune system contributes to the development of infection after stroke. The suppression of systemic immunity by the nervous system is thought to protect the brain from further inflammatory insult, yet this comes at the cost of increased susceptibility to infection after stroke. To improve patient outcome, there have been attempts to lessen the stroke-associated bacterial burden through the prophylactic use of broad-spectrum antibiotics. However, preventative antibiotic treatments have been unsuccessful, and therefore have been discouraged. Additionally, with the ever-rising obstacle of antibiotic-resistance, future therapeutic options to reverse immune impairment after stroke by augmentation of host immunity may be a viable alternative option. However, cautionary steps are required to ensure that collateral ischemic damage caused by cerebral inflammation remains minimal.

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“…In this study we examined the effects of pneumonia on the immune response to MBP and stroke outcome. Staphylococcus aureus and Pseudomonas aeruginosa are common respiratory pathogens after stroke and chosen here as prototypes of Gram-positive and Gram-negative infections (Hassan et al, 2006; Hilker et al, 2003; Tanzi et al, 2011; Walter et al, 2007; Yan et al, 2015). Broad spectrum antibiotics used for empiric treatment of infection include β-lactams and fluoroquinolones; we chose ceftiofur and enrofloxacin as representatives of each class.…”

Section: 1 Introductionmentioning

confidence: 99%

The contribution of antibiotics, pneumonia and the immune response to stroke outcome

Becker

Zierath

Kunze

et al. 2016

Journal of Neuroimmunology

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Background Infections are common following stroke and associated with worse outcome. Using an animal model of pneumonia, we assessed the effect of infection and its treatment on the immune response and stroke outcome. Methods Lewis rats were subjected to transient cerebral ischemia and survived for 4 weeks. One day after stroke animals were exposed to aerosolized Staphylococcus aureus, Pseudomonas aeruginosa or saline. Antibiotics (ceftiofur or enrofloxacin) were started immediately after exposure or delayed for 3 days. Behavioral tests were performed weekly. ELISPOT assays were done on lymphocytes from spleen and brain to assess autoimmune responses to myelin basic protein (MBP). Results Among animals that received immediate antibiotic therapy, infection was associated with worse outcome in ceftiofur but not enrofloxacin treated animals. (The outcome with immediate enrofloxacin therapy was so impaired that further worsening may have been difficult to detect.) A delay in antibiotic therapy was associated with better outcomes in both ceftiofur and enrofloxacin treated animals. Infection was associated with an increased likelihood of developing Th1(+) responses to MBP in non-infarcted brain (OR=2.94 [1.07, 8.12]; P=0.04), and Th1(+) responses to MBP in spleen and non-infarcted brain were independently associated with a decreased likelihood of stroke recovery (OR=0.16 [0.05, 0.51; P=0.002 and OR=0.32 [0.12, 0.84]; P=0.02, respectively). Conclusions Infection worsens stroke outcome in ceftiofur treated animals and increases Th1 responses to MBP. These data may help explain how infection worsens stroke outcome and suggest that treatment of infection may contribute to this outcome.

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Etiologic Diagnosis and Clinical Treatment of Multiple Drug-Resistant Bacteria Infection in Elderly Patients with Stroke-Associated Pneumonia After Neurosurgery

Cited by 8 publications

References 26 publications

Immunomodulation after ischemic stroke: potential mechanisms and implications for therapy

Immunomodulation after ischemic stroke: potential mechanisms and implications for therapy

Ischemia, Immunosuppression and Infection—Tackling the Predicaments of Post-Stroke Complications

The contribution of antibiotics, pneumonia and the immune response to stroke outcome

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