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The Prevalence, Predictors, and In-Hospital Outcomes of Stroke-Associated Infection in Acute Ischemic Stroke: A

Shausha Mohamed Anees1, Xiong Khee Cheong1, Hui Jan Tan2

  • 1Infectious Disease Unit, Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Cheras 56000, Malaysia.

Journal of Clinical Medicine
|July 15, 2026
PubMed

Insights

Stroke-associated infection (SAI) affects nearly one-fifth of acute ischemic stroke patients, increasing hospital stays and mortality. Higher stroke severity scores predict SAI, highlighting the need for early prevention strategies.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Clinical Research

Background:

  • Stroke-associated infection (SAI) is a frequent complication following acute ischemic stroke.
  • Limited contemporary prospective data exists for SAI in Southeast Asia.
  • SAI is linked to poorer clinical outcomes and increased mortality.

Purpose of the Study:

  • To determine the prevalence of SAI in patients hospitalized with acute ischemic stroke.
  • To identify clinical predictors associated with the development of SAI.
  • To evaluate the relationship between SAI and in-hospital outcomes.

Main Methods:

  • Prospective observational cohort study of 390 adult acute ischemic stroke patients.
  • SAI defined as clinically diagnosed infection within seven days of stroke onset.
  • National Institutes of Health Stroke Scale (NIHSS) for stroke severity and modified Rankin Scale (mRS) for functional outcome were used.

Main Results:

  • The prevalence of SAI was 19.2%, with pneumonia being the most common type (14.4%).
  • Higher NIHSS scores (OR 1.10) and mechanical thrombectomy (OR 3.02) were independent predictors of SAI.
  • SAI patients experienced longer hospital stays, worse functional outcomes (mRS 3-6 in 81.3%), and higher in-hospital mortality (17.3%).

Conclusions:

  • Approximately one-fifth of acute ischemic stroke patients develop SAI, significantly impacting outcomes.
  • Stroke severity and specific treatments are associated with increased SAI risk.
  • Findings underscore the importance of early risk stratification and targeted preventive measures for SAI in acute stroke care.
Keywords:
NIHSSacute ischemic strokefunctional outcomemodified Rankin Scalepneumoniastroke-associated infection

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