Pathogen colonization in patients with acute cerebral stroke.
OBJECTIVE
To identify the pathogens that frequently cause infection and to explore their clinical features in acute stroke patients.


METHODS
From June 1, 1999 to December 31, 2008, we reviewed medical records of 263 patients with acute stroke and 351 controls. Within 30 days from admission, 109 and 107 patients had one or more bacterial cultures, respectively. The cumulative bacteria-free probability of all patients and the incidence of each isolated pathogen were assessed. We searched for the factors associated with isolation of different Gram-negative bacilli (GNB).


RESULTS
Patients with recent stroke were prone to healthcare-associated colonization within 2 weeks from admission. One-fourth of stroke patients had positive bacterial culture. Stroke patients had a high incidence of Staphylococcus aureus and various GNB in their sputum. When urinary tract infections (UTIs) began 9 days or more after admission, the contributory pathogens were most often glucose-nonfermenting bacilli. However, if UTIs occurred within 9 days after admission, the pathogens were likely to be Enterobacteriaceae bacilli.


CONCLUSIONS
Stroke patients had high incidence of pathogenic bacteria in their sputum which might be prone to pneumonia. The time after admission of the onset of UTI is useful information for predicting contributory pathogens and planning for appropriate treatment.
Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Kwang-Hwa
KH
Chang
Tsan-Hon
TH
Liou
Chin-I
CI
Chen
Chien-Hua
CH
Wu
Wen-Yen
WY
Hsu
Tsong-Yih
TY
Ou
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000150:complications / Q000453:epidemiology*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D006090:Gram-Negative Bacteria / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D020521:Stroke / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D014552:Urinary Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology