Abstract
Background: The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV).Methods: In this observational study, included patients were divided into SAP and non-SAP based on a comprehensive analysis of symptom, imaging, and laboratory results. Baseline characteristics, clinical characteristics, microbiology, and outcomes were recorded and evaluated.Results: Of 200 patients, 42.5% developed SAP after the onset of stroke, and they had a lower proportion of non-smokers (p = 0.002), lower GCS score (p < 0.001), higher serum CRP (p < 0.001) at ICU admission, and a higher proportion of males (p < 0.001) and hypertension (p = 0.039) than patients with non-SAP. Gram-negative aerobic bacilli were the predominant organisms isolated (78.8%), followed by Gram-positive aerobic cocci (29.4%). The main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP prolonged length of MV (p < 0.001), duration of ICU stay (p < 0.001) and hospital stay (p = 0.027), shortened MV-free days by 28 (p < 0.001), and caused elevated vasopressor application (p = 0.001) and 60-day mortality (p = 0.001). Logistic regression analysis suggested that patients with coma (p < 0.001) have a higher risk of developing SAP.Conclusion: The microbiology of SAP is similar to early phase of HAP and VAP. SAP prolongs the duration of MV and length of ICU and hospital stays, but also markedly increases 60-day mortality.
Highlights
The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV)
200 patients were eligible for further analysis, and those were divided into two groups as SAP (n = 85) and non-SAP (n = 115) according to the microbiological results of sputum samples (Figure 1)
Hemorrhagic stroke was the main type of stroke (90.6, 93.9%, respectively, p = 0.38) and over fifty percent of patients had the symptom of vomiting (56.5, 50.4%, respectively, p = 0.40) (Table 1)
Summary
The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent.Purpose: To determine the microbiology and outcomes of SAP in the lower respiratory tract (LRT) for patients with invasive mechanical ventilation (MV). The attributable mortality and microbial etiology of stroke-associated pneumonia (SAP) vary among different studies and were inconsistent. The trachea, main bronchus, and bronchus at various levels in the lung are uniformly called lower respiratory tract (LRT), having the ability to eliminate microbes and purify inhaled gas. Risk factors included dysphagia, impaired consciousness, and ineffective cough reflex, as they impaired the ability of the LRT of eliminating microbes from oropharyngeal contents and so allow pathogens to enter the lung (DiBardino and Wunderink, 2015; Mandell and Niederman, 2019). In recent studies, elevated bronchoalveolar lavage (BAL) amylase levels were associated with a high risk of aspiration and positiveculture, while serum procalcitonin (PCT) was associated with a prognosis of aspiration pneumonia (AP) (El-Solh et al, 2011; Weiss et al, 2013; DiBardino and Wunderink, 2015; Legriel et al, 2019; Mandell and Niederman, 2019). It is common to apply mechanical ventilation (MV) on critically ill patients to maintain normal gas exchange, the mechanical force from MV could
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
