Retrospective Investigation Of Stroke-associated Pneumonia In Neurological Intensive Care Unit

Stroke-associated pneumonia (SAP) is defined as newly developed pneumoniafollowing stroke onset in the patients without previous respiratory infection. As one of themost common and serious complications in acute stroke, SAP infects about one thirdpatients of30-day death. Although previous studies reported a number of risk factors, theindependent clinical predictors of SAP have not been determined yet. Furthermore, thedetailed data about SAP in our country are rare, and so is the comprehensive and systematicexploration for SAP in the neurological intensive care unit(NICU). Therefore, our studyinvestigates the status and clinical factors of SAP in patients with acute stroke, try toconfirm the independent clinical predictors, pathogens and treatment response related toSAP, aiming to raise awareness of SAP and prove relevant preventive measures.Methods: Retrospective study method is used to investigate and observe the clinicinformation of patients with acute stroke (onset within2weeks) in NICU of our hospitalfrom January1st,2010to January1st,2011. Statistical analysis is conducted by SPSS forWindows Ver.17.0statistical software. Measurement data are expressed by x±se, and countdata are expressed by rate (%) and (or) constituent ratio (%). The association between SAPonset and potential predisposing factors were assessed using χ~2test, t test, rank-sum test andmulti-factor non-conditional Logistic regression model for predictor identification. Andvarious statistics methods are used to compare the differences of complications, outcomeand medical expenses between SAP and nSAP groups, such as χ~2test, Fisher exact,rank-sum test.Results:1、In404stroke patients, the incidence of SAP was175(43.3%), concluding119(68.0%) early onset pneumonia（EOP) and56(32.0%) late onset pneumonia(LOP).2、The risk factors of SAP in multi-factor non-conditional Logistic regression analysis are asfollowing, age≥70years, diabetes mellitus, vomiting, dysphagia, hypoalbuminemia, tubefeeding and mechanical ventilation.3、The incidence of other complications is higher inSAP group than that in nSAP group, including upper gastrointestinal bleeding, abnormalrenal function, abnormal liver function. And the short-term outcome of nSAP is better thanthat of SAP group.4、Patients had shorter length of stay (LOS), less total costs of hospitalization and daily costs of hospitalization in nSAP group than in SAP group.5、117patients (66.9%) in SAP group underwent sputum culture, and76of them (65.0%) havepositive results, with Gram-negative bacteria accounting for76.9%, Gram-positive bacteriaaccounting for12.0%, fungi accounting for29.1%.6、78.7%of SAP patients changingantibiotics to sputum culture results displayed good response to antibiotic treatment,comparing to54.5%of the other SAP patients. And the difference between them wasstatistically significant（P＜0.05）.7、Antimicrobial agents which Klebsiella pneumoniaesensitive to were mainly imipenem, meropenem and cefepime; Escherichia coli sensitive tocefoperazone/sulbactam, amikacin, ceftazidime； Acinetobacter baumannii sensitive toimipenem, meropenem and cotrimoxazole； Pseudomonas aeruginosa sensitive tociprofloxacin, levofloxacin, amikacin；Antimicrobial agents which Staphylococcus aureussensitive to were mainly linezolid, vancomycin and teicoplanin; Staphylococcus aureusstrains were all methicillin-resistant Staphylococcus aureus (MRSA).Conclusions: Most SAP of NICU patients occur within3days after stroke onset. Age≥70years, diabetes mellitus, vomiting, dysphagia, hypoalbuminemia, tube feeding andmechanical ventilation may be the independent clinical predictors of SAP. Pathogens ofSAP were mainly Gram-negative bacteria. SAP may lead to increased incidence of othercomplications, prolonged hospitalization and increased treatment costs.