title: Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine.
abstract: OBJECTIVE
  Pneumonia has been estimated to occur in about one third of patients after acute stroke. Only limited data are available on stroke-associated pneumonia (SAP) in specialized neurological intensive care units (NICUs).
  
  
  METHODS
  We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospective observational study. Incidence rates and risk factors of SAP and long-term clinical outcome were determined.
  
  
  RESULTS
  SAP incidence was 21% with a spectrum of pathogens, which is comparable to previously published data on general ICU patients. Mechanical ventilation, multiple location, and vertebrobasilar stroke, as well as dysphagia and abnormal chest x-ray findings, were identified as risk factors for the disease. SAP patients showed higher mortality rates than nondiseased subjects (acute, 26.9% versus 8.2%; long-term, 35.3% versus 14.3%) and a significantly poorer long-term clinical outcome (Barthel Index, 50.5+/-42.4 versus 81.5+/-27.8; Rankin Scale, 3.5+/-1.7 versus 2.2+/-1.6).
  
  
  CONCLUSIONS
  Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting. They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients. Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising.
authors.affiliation: Department of Neurology, University Hospital, Cologne, Germany.
authors.forename: Ruediger
authors.initials: R
authors.lastname: Hilker
authors.forename: Carsten
authors.initials: C
authors.lastname: Poetter
authors.forename: Nahide
authors.initials: N
authors.lastname: Findeisen
authors.forename: Jan
authors.initials: J
authors.lastname: Sobesky
authors.forename: Andreas
authors.initials: A
authors.lastname: Jacobs
authors.forename: Michael
authors.initials: M
authors.lastname: Neveling
authors.forename: Wolf-Dieter
authors.initials: WD
authors.lastname: Heiss
mesh_terms: D000208:Acute Disease; D000368:Aged; D020520:Brain Infarction / Q000150:complications; D002545:Brain Ischemia / Q000150:complications; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009462:Neurology; D011014:Pneumonia / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000628:therapy; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications*