title: Impact of stroke-associated infection on long-term survival: a cohort study.
abstract: OBJECTIVE
  The effects of stroke-associated infection (SAI) on long-term survival are unclear. We performed a prospective evaluation to explore risk factors of SAI, and compared survival status over the 3 years following stroke onset between those who experienced SAI and those who did not.
  
  
  METHODS
  Consecutive patients with acute stroke admitted to a stroke unit between April 2005 and December 2006 were invited to participate. We prospectively collected data on demographics, pathological and clinical stroke subtype, stroke severity, and neurological and functional consequences, and abstracted additional data on occurrence and timing of SAI in hospital from medical notes. Survival status 3 years after stroke onset was obtained.
  
  
  RESULTS
  We recruited 413 acute stroke patients, 161 (39%) experienced SAI. After excluding patients with infection at onset, patients with intracerebral haemorrhage (p=0.014), dysphagia (p=0.003) and urinary incontinence/catheterisation (p=0.000) were at higher risk of infection after controlling for case mix. The risk of death in hospital was greater following an SAI (HR 3.56; 95% CI 1.94 to 6.53; p=0.000), as was risk of death calculated over the whole 3-year follow-up period among those acquiring SAI within 2 weeks of onset (HR 1.66; 95% CI 1.14 to 2.40; p=0.031).
  
  
  CONCLUSIONS
  SAIs have long-lasting effects on patient survival. This serves to emphasise the importance of immediate access to organised stroke unit care for people with acute stroke, with active physiological monitoring and protocols for early detection and treatment of SAIs.
authors.affiliation: The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth, UK.
authors.forename: Joseph
authors.initials: J
authors.lastname: Kwan
authors.forename: Ruth Mary
authors.initials: RM
authors.lastname: Pickering
authors.forename: Dorit
authors.initials: D
authors.lastname: Kunkel
authors.forename: Carolyn
authors.initials: C
authors.lastname: Fitton
authors.forename: Damian
authors.initials: D
authors.lastname: Jenkinson
authors.forename: V Hugh
authors.initials: VH
authors.lastname: Perry
authors.forename: Ann M
authors.initials: AM
authors.lastname: Ashburn
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007239:Infections / Q000150:complications / Q000401:mortality*; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors