Nosocomial Pneumonia After Acute Stroke

Abstract

Background and Purpose-Pneumonia has been estimated to occur in about one third of patients after acute stroke. Only limited data are available on stroke-associated pneumonia (SAP) in specialized neurological intensive care units (NICUs). Methods-We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospective observational study. Incidence rates and risk factors of SAP and long-term clinical outcome were determined. Results-SAP incidence was 21% with a spectrum of pathogens, which is comparable to previously published data on general ICU patients. Mechanical ventilation, multiple location, and vertebrobasilar stroke, as well as dysphagia and abnormal chest x-ray findings, were identified as risk factors for the disease. SAP patients showed higher mortality rates than nondiseased subjects (acute, 26.9% versus 8.2%; long-term, 35.3% versus 14.3%) and a significantly poorer long-term clinical outcome (Barthel Index, 50.5Ϯ42.4 versus 81.5Ϯ27.8; Rankin Scale, 3.5Ϯ1.7 versus 2.2Ϯ1.6). Conclusions-Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting. They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients. Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising.

Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

“…Table 1. Results of univariate analysis of risk factors for non-ventilator associated hospital acquired-pneumonia CNS diseases may depress cough reflexes, impair swallowing mechanisms and affect respiratory patterns [17]. All these alterations facilitate the access of microorganisms to the lower airways.…”

Sensitization to Brain Antigens after Stroke is Augmented by Lipopolysaccharide

“…As such, our data may offer an explanation as to why infection during stroke is associated with worse outcome from stroke. Because Gram-negative bacteria are the predominant organisms causing infection after stroke, the use of LPS in these experiments is clinically relevant (Hilker et al, 2003;Puri et al, 2002). Future studies will need to address whether infection with other pathogens after stroke would similarly predispose to CNS autoimmunity.…”

“…Since Gram-negative bacteria are the predominant organisms causing infection after stroke, we modeled the systemic inflammatory response to infection with lipopolysaccharide (LPS), a component of the Gram-negative bacterial cell wall (Hilker et al, 2003;Puri et al, 2002). The aim of these experiments was to determine whether LPS-induced inflammation during stroke would increase the likelihood of developing an immune response to brain antigens.…”

Importance of T Lymphocytes in Brain Injury, Immunodeficiency, and Recovery after Cerebral Ischemia

“…Infectious complications, predominantly chest and urinary tract infections, occur in many stroke patients within the first few days after stroke, and development of an infection early after stroke is known to be associated with worse outcomes (Aslanyan et al, 2004;Hilker et al, 2003;Langhorne et al, 2000). The signals and mechanisms that trigger the SNS and the HPA to induce stroke-induced immunodepression remain unclear.…”