Prevalence and Factors Associated with Infections After Acute Ischemic Stroke: A Single-Center Retrospective Study...

Infections following cerebrovascular accidents represent a severe medical complication that significantly alters patient recovery trajectories and long-term functional outcomes. Prior research has shown that these secondary complications frequently exacerbate neurological deficits and increase mortality rates in clinical settings worldwide. Existing literature predominantly focuses on Western cohorts, leaving a substantial knowledge deficit regarding the specific microbial landscape and resistance patterns in Asian populations. Clinicians require precise data on pathogenic profiles to optimize empirical antibiotic therapies and improve survival outcomes for hospitalized individuals undergoing acute care. The emergence of the Coronavirus Disease 2019 (COVID-19) pandemic introduced unprecedented variables into hospital environments, potentially shifting traditional infection patterns and healthcare delivery models. Understanding these shifts is essential for maintaining high standards of care during global health crises that strain medical resources. This absence of evidence motivated the current investigation into the bacterial and fungal landscapes affecting stroke survivors over a comprehensive five-year period.

Researchers sought to characterize the bacterial and fungal profiles of pathogenic organisms causing infections after Acute Ischemic Stroke (AIS) in a specialized setting. The investigation targeted the identification of specific risk factors associated with positive microbiologic cultures in a tertiary stroke hospital serving a diverse Asian demographic. Analysts aimed to compare infection prevalence and microbial resistance patterns between the pre-pandemic era and the transformative COVID-19 period. The project evaluated how various clinical interventions, such as intensive care placement or the use of invasive devices, influenced the likelihood of secondary infections. This work intended to provide a foundational dataset for developing targeted preventive measures like early dysphagia screening protocols and improved hygiene standards. Identifying these associations helps neurologists predict which patients are most vulnerable to hospital-acquired pathogens during their recovery. By examining a large retrospective cohort, the team hoped to clarify the impact of hospital-acquired pathogens on the Asian stroke population and guide future clinical guidelines.

This retrospective analysis utilized medical records from patients aged eighteen or older hospitalized with Acute Ischemic Stroke (AIS) between 2018 and 2022. Investigators extracted demographic details, patient-related variables, and diagnostic examination data from a centralized tertiary hospital database to ensure data consistency. The team defined post-stroke complications as any infection developing during the acute phase confirmed by microbiologic culture as the gold standard for diagnosis. Statistical experts employed multiple logistic regression to determine the strength of associations between clinical factors and infection occurrences while controlling for confounding variables. The study period was bifurcated to assess the specific influence of the COVID-19 pandemic on pathogen distribution and antimicrobial susceptibility across different hospital environments. Microbial identification focused on isolating specific strains from various bodily sources, with a primary emphasis on sputum samples obtained through standardized collection techniques. Researchers also monitored the use of specific medical interventions like tracheostomy and total parenteral nutrition to assess their correlation with culture results.

Analysis of 599 patients revealed a 21.4% prevalence of infections characterized by isolated pathogenic organisms during the five-year observation window. Sputum samples served as the primary source for most identified pathogens, while fungal isolates remained notably rare throughout the entire patient cohort. Positive microbiologic cultures frequently identified Klebsiella pneumoniae (K. pneumoniae), Escherichia coli (E. coli), Acinetobacter baumannii (A. baumannii), and Staphylococcus aureus (S. aureus). During the COVID-19 era, Gram-negative bacteria demonstrated increased resistance to ̢-lactamase antibiotics, while Gram-positive strains showed heightened methicillin resistance compared to earlier periods. Intensive ward care, including the stroke unit, correlated with a reduced risk of positive cultures across both pandemic and non-pandemic intervals. Urinary catheters increased infection risk during the non-COVID-19 period, whereas steroids and total parenteral nutrition (TPN) showed negative associations during the pandemic phase. These findings highlight how environmental changes and clinical practices influenced the microbial landscape during a major public health emergency.

The prevalence and underlying factors of secondary infections in stroke patients underwent significant shifts during the COVID-19 pandemic, reflecting broader changes in healthcare. These findings underscore the necessity of adapting clinical management strategies to account for evolving antimicrobial resistance patterns in hospital settings to ensure patient safety. Effective prevention of post-stroke complications requires the implementation of rigorous screening tools, particularly for identifying early-stage dysphagia that leads to aspiration pneumonia. Clinicians should prioritize specialized care in intensive stroke units to mitigate the risk of acquiring hospital-associated bacterial pathogens through enhanced monitoring. Future research must continue monitoring the long-term impacts of pandemic-related environmental changes on microbial ecology within neurology departments to refine treatment protocols. The study provides essential evidence for refining antibiotic stewardship programs tailored to the specific needs of Asian ischemic stroke survivors facing complex recovery challenges. Implementing these evidence-based strategies could significantly reduce the burden of secondary infections and improve the overall prognosis for stroke patients.