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A systematic review and meta-analysis show a decreasing prevalence of post-stroke infections
Aaron Awere-Duodu1, Samuel Darkwah1, Abdul-Halim Osman1
1Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana.
Background:
Infection is a common complication in the acute phase after stroke; a systematic review in 2011 reported a post-stroke infection prevalence of 30%. Despite the plethora of primary data on post-stroke infections in recent times, a systematic review that synthesizes the data to provide comprehensive information to guide preventive, control, and management efforts is yet to be undertaken. This systematic review, therefore, aimed at bridging this gap by describing the epidemiology of post-stroke infections including the global prevalence and the associated mortality rates.
Methodology:
A comprehensive search was conducted in PubMed, SCOPUS, and Web of Science resulting in 2210 studies, of which 73 studies covering 32,109,574 stoke patients were included in the systematic review. Prevalence data on defined post-stroke infections were extracted for analysis in RStudio version 4.3.3.
Results:
The pooled prevalence of post-stroke infections and mortality rates were 9.14% and 15.91% respectively. The prevalence of post-stroke infections was highest for pneumonia (12.4%), followed by urinary tract infection (8.31%). Geographically, the prevalence of post-stroke infections for the various continents were Europe (10.41%), Africa (10.22%), South America (8.83%), North America (8.15%), Asia (8.09%), and Australia (7.88%). Common etiological agents of post-stroke infections included multidrug-resistant organisms particularly, Carbapenem-resistant Klebsiella pneumoniae (15.4-31.8%), Methicillin-resistant Staphylococcus aureus (9.8-15.4%), and Carbapenem-resistant Acinetobacter baumannii (38.5%).
Conclusion:
This systematic review indicates about a 3-fold decline in the global prevalence of post-stroke infections in the last decade. Pneumonia is the most common post-stroke infection. Europe and Africa have the highest prevalence of post-stroke infections.
Insights
Post-stroke infections have declined significantly, with pneumonia being the most common. Europe and Africa show the highest infection rates, highlighting areas for targeted prevention and control strategies.
Area of Science:
- Epidemiology
- Infectious Diseases
- Neurology
Background:
- Post-stroke infections are a significant complication, with previous reviews reporting up to 30% prevalence.
- A comprehensive synthesis of current data is needed to guide prevention and management strategies.
- This systematic review addresses the gap by detailing the epidemiology, global prevalence, and mortality rates of post-stroke infections.
Approach:
- A systematic review was conducted using data from 2210 studies.
- 73 studies, encompassing over 32 million stroke patients, were included in the final analysis.
- Prevalence data were extracted and analyzed using RStudio version 4.3.3.
Key Points:
- The pooled prevalence of post-stroke infections is 9.14%, with a mortality rate of 15.91%.
- Pneumonia (12.4%) and urinary tract infections (8.31%) are the most prevalent infections.
- Prevalence varies geographically, with Europe (10.41%) and Africa (10.22%) having the highest rates.
Conclusions:
- Global post-stroke infection prevalence has decreased approximately threefold in the past decade.
- Pneumonia remains the most frequent post-stroke infection.
- Higher infection prevalence in Europe and Africa necessitates focused public health interventions.
