Risk Factors Of Acute Stroke-Associated Pneumonia And The Etiology Feature

Objective:To investigate the morbidity and mortality of stroke-associated pneumonia in our hospital; to analyze the influence of basic state and treatment after admission on acute stroke-associated pneumonia and analyze the microbiology of sputum bacterial culture, guiding the clinical therapy.Methods:First,a retrospective analysis was carried out to invesgate the2573stroke patients admitted to the neurology at our hospital during January1st,2009to January1st2012including2199ischemic stroke and374cerebral hemorrhage patient,to invesgate the morbidity and mortality of stroke-associated pneumonia, and the relationship between stroke type and SAP. Then a case-control study was conducted with167patients selected randomly from the acute stroke associated pneumonia group and179cases of control group selected randomly from the acute stroke non pneumonia group,paired them according to stroke type. Two main aspects of stroke patients were observed:basic state,including gender,age,diabetes, heart disease, lung disease, smoking, the length of hospital stay, Glasgow coma score (GCS score), NIH Stroke Scale (NIHSS score), Dysphagia; treatment after admission, including tracheotomy, endotracheal intubation, mechanical ventilation, indwelling gastric tube, acid-suppressive drugs such as proton pump inhibitors (PPIs) and H2receptor blockers (H2Ras), dehydrating agent, the prophylactic use of antibiotics.The data were analyzed through the application of SPSS17.0software, T-test was used to explore the differences in clinical variables of patients and chi-square test was used to analyze the frequencies between groups. Logistic regression analysis was performed to identify all the clinical variables after Univariate Analysis,and the difference was significant when p<0.05.Results:1.Of the2573stroke patients,187(7.27%)patients occurred SAP. The incidence of the cerebral infarction was5.68%, and the incidence of cerebral hemorrhage was16.58%that higher than the group of cerebral infarction, the difference had statistical significance (χ2=54.67,P<0.01). The deaths of all the stroke patients was44(1.7%), while the deaths of SAP was20(10.7%), and the deaths of non SAP was24(1.0%). the difference had statistical significance (χ2=92.28.P<0.01).2. In the case control study, the average length of stay(LOS) of SAP(19.2±13.4) was longer than the control group(13.8±7.7). The difference had statistical significance by t test(t=5.785, P <0.05).3. In single factor analysis there were eleven factors that had statistical difference between the two groups, they were gender, age, heart disease, lung disease, Glasgow coma score≤8, NIH Stroke Scale>10, dysphagia, tracheotomy, mechanical ventilation, indwelling gastric tube and acid-suppressive drugs(P<0.05).4.To mean acute stroke-associated pneumonia as dependent variables(SAP=1;no SAP=0).11factors which were selected by univariate Analysis were independent variables. The influence of their risk factors can be seen in this order:old age(5.408), lung disease(4.686), dysphagia(4.202), Glasgow coma score(3.275), heart disease(2.416), acid-suppressive drugs(2.347)by odds ratio(OR) value from logistic regression analysis.5.Of167SAP patients,195copies specimen were cultivated which cultivated16pathogens,181strains. Gram negative bacilli accounted for55.25%, including Bauman Acinetobacter, Pseudomonas aeruginosa, Klebsiella pneumonae, Enterobacter cloacae, Escherichia coli; gram positive cocci accounted for17.13%, including Staphylococcus aureus (methicillin-resistant Staphylococcus epidermidis, methicillin-resistant Staphylococcus aureus), Streptococcus, Enterococcus faecium;fungi accounted for26.52%, including white candidiasis, Candida glabrata, Candida tropicalis, Candida krusei;gram positive bacilli accounted for1.1%. Conclusions:1. Acute stroke-associated pneumonia is associated with a high mortality and prolongs the hospital stay.2. Old age, lung disease, dysphagia, decreased consciousness, heart disease, acid-suppressive drugs may be the independent risk factors of SAP.3.The pathogens of acute stroke associated pneumonia are mostly opportunistic bacteria, the most of them were gram-negative bacilli, mainly Bauman Acinetobacter, Pseudomonas aeruginosa, Klebsiella pneumonae; the most of gram positive cocci are Staphylococcus aureus and Streptococcus; the most of the fungi are white candidiasis.