Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort
Jie Zhao1, Lei-Qing Li1, Ning-Xin Zhen1
1Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Abstract:
Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent. Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV). Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated. Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP. Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.
Insights
Stroke-associated pneumonia (SAP) affects nearly half of stroke patients on mechanical ventilation, predominantly caused by Gram-negative bacteria. SAP significantly increases mortality, ventilation duration, and hospital stays.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Neurology
Background:
- Inconsistent data exists regarding the mortality and microbial causes of stroke-associated pneumonia (SAP).
- Understanding the specific microbiology and outcomes of SAP in patients requiring invasive mechanical ventilation (MV) is crucial.
Purpose of the Study:
- To investigate the microbial etiology of lower respiratory tract infections in stroke patients.
- To determine the clinical outcomes associated with stroke-associated pneumonia in patients on mechanical ventilation.
Main Methods:
- An observational study involving 200 patients admitted to the ICU following a stroke.
- Patients were categorized into stroke-associated pneumonia (SAP) and non-SAP groups based on clinical, imaging, and laboratory findings.
- Data collected included baseline characteristics, clinical course, lower respiratory tract microbiology, and patient outcomes.
Main Results:
- SAP developed in 42.5% of stroke patients, associated with lower Glasgow Coma Scale scores, higher C-reactive protein levels, and higher prevalence of male sex and hypertension.
- Predominant pathogens identified were Gram-negative aerobic bacilli (78.8%), including *K. pneumoniae*, *A. baumannii*, and *P. aeruginosa*, followed by Gram-positive cocci (29.4%), including *S. aureus*.
- SAP significantly prolonged mechanical ventilation duration, ICU and hospital stays, reduced ventilator-free days, increased vasopressor use, and elevated 60-day mortality. Coma was a significant risk factor for SAP development.
Conclusions:
- The microbial profile of SAP resembles that of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in their early stages.
- Stroke-associated pneumonia substantially increases the duration of mechanical ventilation and intensive care unit/hospital stays.
- SAP is associated with a marked increase in 60-day mortality among stroke patients requiring mechanical ventilation.
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