Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine.
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.
Hilker
Ruediger
R
Department of Neurology, University Hospital, Cologne, Germany.
Poetter
Carsten
C
Findeisen
Nahide
N
Sobesky
Jan
J
Jacobs
Andreas
A
Neveling
Michael
M
Heiss
Wolf-Dieter
WD
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*