Risk Factors And Clinical Haracteristics For Stroke-associated Pneumonia

Background Stroke is harmful to human life and health, have higher morbidity and mortality. In recent years our county epidemiological data suggest, stroke is the first or second cause of death in the population. Our county is big county of stroke. Countrywide new stroke patients is about2000000people each year. Reported in the literature, the prognosis of these patients depends on the associated complications, and infections are the most common complications, including respiratory system gastrointestinal、urinary system、skin and other parts of the infection. The respiratory system infection rate was the highest, reaching7%-22%, neurological intensive care unit is amounted to47.3%. After acute stroke associated pneumonia,not only increase the stroke treatment difficulty, increase the economic buren of stroke patients, also increased the stroke mortality. In2003, Hiker proposed the concept of stroke associated pneumonia (SAP). In2010, China has formulated the Chinese expert consensus on diagnosis and treatment of stroke associated pneumonia. Stroke associated pneumonia definition、diagnosis、risk factors、prevention comprehensive treatment and antibiotic therapy were detailed description. This paper dicusses the incidence、risk factors and microorganism of the stroke associated pneumonia after acute stroke.In the clinical work, expect to control the associated risk factors, reduce the incidence of SAP;the SAP patients timely diagnosis and treatment, reduce the mortality rate. Objective To ascertain the incidence、risk factors、microorganism of stroke-associated pneumonia(SAP) and mortality in acute stroke patients. Methods We retrospectively investigate clinical data of642patients of acute stroke treated in the general ward of Shandong Provincial Hospital affiliated to Shandong University between Jan2009and Dec2010. They were divided into SAP and non-SAP. Univariate analysis and multivariate logistic regression analysis were used to analyze the related risk factors for SAP. And analyze the pathogens. Results The incidence of SAP in642patients of acute stroke was13.2%, in which early-onset pneumonia(EOP)accounted for71.8%. In different types of stroke, the incidence of SAP in cerebral infarct group was10.9%, in cerebral hemorrhage group was19.4%, in subarachnoid hemorrhage group was29.4%(P<0.01). In different locations of stroke, the incidence of SAP in anterior circulation group was8.3%, in posterior circulation group was22.3%, inanterior+posterior circulation group was24.6(P<0.01). The mortality of SAP was31.7%. The risk factors of SAP include age≥65, diabetes, smoking, dysphagia, hypoproteinemia, antibiotic prophylaxis, dehydrant, H2-blocker or inhibitors of proton pump, nasal feeding. The patients with smoking and nasal feeding increased risk of early-onset pneumonia(EOP);the patients with hypoproteinemia and antibiotic prophylaxis increased risk of late-onset pneumonia(LOP). There were65strains obtained by sputum culture. The percentage of the Gram-negative bacteria, the Gram-postive ones, and the fungi was67,7%,26.2%,6.2%. The major strains of Gram-negative were K.pneumoniae, and that of Gram-postive bacteria was Enterococcus, and that of fungi was Candida albicans. Conclusions The most SAP was occurred in the first72hours of admission, of which Gram-negative bacteria play the most important role. The mortality of SAP was quite high in acute stroke. The incidence rate of SAP is different between different types and locations.The risk factors are different between EOP and LOP.