Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction

NanZhu, Yang; Li, Xin; Xianghua, Yun; Chen, Jun; Li, Min

doi:10.1097/md.0000000000015045

Cited by 19 publications

(18 citation statements)

References 43 publications

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“…Furthermore, stroke severity, as measured by the NIHSS, was associated with SAP (OR=1.159). Many studies showed similar results, i.e., that patients with high NIHSS score were more likely to develop pneumonia after stroke,25–27 which were consistent with our findings. Some studies showed that atrial fibrillation was significantly more prevalent in patients who developed pneumonia in the acute stroke stage, with ORs ranging from 1.96 to 3.30 28–30.…”

Section: Discussionsupporting

confidence: 91%

<p>Individualized Prediction Of Stroke-Associated Pneumonia For Patients With Acute Ischemic Stroke</p>

Huang¹,

Lin²,

Wu³

et al. 2019

CIA

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BackgroundStroke-associated pneumonia (SAP) is a serious and common complication in stroke patients.PurposeWe aimed to develop and validate an easy-to-use model for predicting the risk of SAP in acute ischemic stroke (AIS) patients.Patients and methodsThe nomogram was established by univariate and multivariate binary logistic analyses in a training cohort of 643 AIS patients. The prediction performance was determined based on the receiver operating characteristic curve (ROC) and calibration plots in a validation cohort (N=340). Individualized clinical decision-making was conducted by weighing the net benefit in each AIS patient by decision curve analysis (DCA).ResultsSeven predictors, including age, NIHSS score on admission, atrial fibrillation, nasogastric tube intervention, mechanical ventilation, fibrinogen, and leukocyte count were incorporated to construct the nomogram model. The nomogram showed good predictive performance in ROC analysis [AUROC of 0.845 (95% CI: 0.814–0.872) in training cohort, and 0.897 (95% CI: 0.860–0.927) in validation cohort], and was superior to the A2DS2, ISAN, and PANTHERIS scores. Furthermore, the calibration plots showed good agreement between actual and nomogram-predicted SAP probabilities, in both training and validation cohorts. The DCA confirmed that the SAP nomogram was clinically useful.ConclusionOur nomogram may provide clinicians with a simple and reliable tool for predicting SAP based on routinely available data. It may also assist clinicians with respect to individualized treatment decision-making for patients differing in risk level.

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Section: Discussionsupporting

confidence: 91%

<p>Individualized Prediction Of Stroke-Associated Pneumonia For Patients With Acute Ischemic Stroke</p>

Huang¹,

Lin²,

Wu³

et al. 2019

CIA

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“…The most common post-stroke infections are urinary tract infections, with rates as high as 1 in 4 patients [64], and pneumonia, with rates as high as 25 % [65]. However, not all of these infections are healthcare-associated-in one series, 24 % of stroke patients presented with an infection on admission [66].…”

Section: Ischemic Strokementioning

confidence: 99%

“…Well-documented predictors of post-stroke infection include older age, stroke severity, a larger area of the infarct, and dysphagia [68]. For pneumonia specifically, older age [69][70][71], male sex [70,72], current smoking [73], diabetes mellitus [72], hypertension [74], atrial fibrillation [65,75], congestive heart failure [71,75], chronic obstructive pulmonary disease [75], tachypnea and intubation [76], preexisting dependency [75,77], stroke severity [65,75,76], stroke subtype [76], dysphagia [76], and nutritional factors [65,75] have been found to pose risk. Stroke-associated pneumonia not only increases morbidity and mortality [78] but also clinical outcomes after discharge [65] as well as healthcare costs and LOS [79].…”

Section: Ischemic Strokementioning

confidence: 99%

Healthcare-Associated Infections in the Neurocritical Care Unit

Busl

2019

Curr Neurol Neurosci Rep

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Purpose of Review This article summarizes updated data and knowledge on healthcare-associated infections in the neurocritical care unit, with a focus on central nervous system infections and systemic infectious complications in patients with acute brain disease. It also reviews the concept of brain injury-induced immune modulation, an underlying mechanism to explain why the neuro-ICU population is particularly susceptible to infections. Recent Findings Healthcare-associated infections in the neuro-ICU are common: up to 40 % of meningitides in the developed world are now healthcare-associated. The number of gram-negative infections is rising. New diagnostic approaches attempt to aid in the diagnosis of healthcare-associated meningitis and ventriculitis. Summary Healthcare-associated infections in the neurocritical care unit remain a challenge for diagnosis, treatment, and prevention. Gaining a better understanding of at-risk patients and development of preventative strategies will be the goal for future investigation.

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“…Although studies of OI and pneumonia remain scarce, in different OI settings both DM and COPD have been identified as significant risk factors for nosocomial pulmonary infections, and patients with DM have been shown to have different and rarer bacterial strains and a significantly higher drug resistance rate than patients without DM [28][29][30][31]. In large cohorts, the pneumonia risk in DM patients seems obvious; López-de-Andrés et al [32] reported a 21% higher incidence of postoperative pneumonia in DM patients than in non-diabetic patients in a cohort of over 100,000 patients, although contradictory results have also been reported [33,34]. Associations between chronic pulmonary disease or DM and pneumonia were not verified in our study; however, the number of patients with a history of these diseases was too low for reliable statistical evaluation.…”

Section: Discussionmentioning

confidence: 99%

Deep odontogenic infections—identifying risk factors for nosocomial pneumonia

et al. 2020

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Objectives To evaluate occurrence and risk factors for pneumonia in patients with deep odontogenic infection (OI). Materials and methods All patients treated for deep OIs and requiring intensive care and mechanical ventilation were included. The outcome variable was diagnosis of nosocomial pneumonia. Primary predictor variables were re-intubation and duration of mechanical ventilation. The secondary predictor variable was length of hospital stay (LOHS). The explanatory variables were gender, age, current smoking, current heavy alcohol and/or drug use, diabetes, and chronic pulmonary disease. Results Ninety-two patients were included in the analyses. Pneumonia was detected in 14 patients (15%). It was diagnosed on postoperative day 2 to 6 (median 3 days, mean 3 days) after primary infection care. Duration of mechanical ventilation (p = 0.028) and LOHS (p = 0.002) correlated significantly with occurrence of pneumonia. In addition, re-intubation (p = 0.004) was found to be significantly associated with pneumonia; however, pneumonia was detected in 75% of these patients prior to re-intubation. Two patients (2%) died during intensive care unit stay, and both had diagnosed nosocomial pneumonia. Smoking correlated significantly with pneumonia (p = 0.011). Conclusion Secondary pneumonia due to deep OI is associated with prolonged hospital care and can predict the risk of death. Duration of mechanical ventilation should be reduced with prompt and adequate OI treatment, whenever possible. Smokers with deep OI have a significantly higher risk than non-smokers of developing pneumonia. Clinical relevance Nosocomial pneumonia is a considerable problem in OI patients with lengthy mechanical ventilation. Prompt and comprehensive OI care is required to reduce these risk factors.

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Risk factors analysis of nosocomial pneumonia in elderly patients with acute cerebral infraction

Cited by 19 publications

References 43 publications

<p>Individualized Prediction Of Stroke-Associated Pneumonia For Patients With Acute Ischemic Stroke</p>

<p>Individualized Prediction Of Stroke-Associated Pneumonia For Patients With Acute Ischemic Stroke</p>

Healthcare-Associated Infections in the Neurocritical Care Unit

Deep odontogenic infections—identifying risk factors for nosocomial pneumonia

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