Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study

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)...

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Autores principales:	Jie Zhao, Lei-qing Li, Ning-xin Zhen, Lin-lin Du, Hui Shan, Yang Yu, Zhao-cai Zhang, Wei Cui, Bao-ping Tian
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	ischemic stroke hemorrhagic stroke pneumonia microbiology outcomes Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/ab0f05030ee0451c97ba3ca5bd1e59b9
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spelling	oai:doaj.org-article:ab0f05030ee0451c97ba3ca5bd1e59b92021-12-03T06:10:19ZMicrobiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study1664-302X10.3389/fmicb.2021.720051https://doaj.org/article/ab0f05030ee0451c97ba3ca5bd1e59b92021-12-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fmicb.2021.720051/fullhttps://doaj.org/toc/1664-302XBackground: 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.Jie ZhaoLei-qing LiNing-xin ZhenLin-lin DuHui ShanYang YuZhao-cai ZhangWei CuiBao-ping TianFrontiers Media S.A.articleischemic strokehemorrhagic strokepneumoniamicrobiologyoutcomesMicrobiologyQR1-502ENFrontiers in Microbiology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	ischemic stroke hemorrhagic stroke pneumonia microbiology outcomes Microbiology QR1-502
spellingShingle	ischemic stroke hemorrhagic stroke pneumonia microbiology outcomes Microbiology QR1-502 Jie Zhao Lei-qing Li Ning-xin Zhen Lin-lin Du Hui Shan Yang Yu Zhao-cai Zhang Wei Cui Bao-ping Tian Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study
description	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.
format	article
author	Jie Zhao Lei-qing Li Ning-xin Zhen Lin-lin Du Hui Shan Yang Yu Zhao-cai Zhang Wei Cui Bao-ping Tian
author_facet	Jie Zhao Lei-qing Li Ning-xin Zhen Lin-lin Du Hui Shan Yang Yu Zhao-cai Zhang Wei Cui Bao-ping Tian
author_sort	Jie Zhao
title	Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study
title_short	Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study
title_full	Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study
title_fullStr	Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study
title_full_unstemmed	Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study
title_sort	microbiology and outcomes of institutionalized patients with stroke-associated pneumonia: an observational cohort study
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/ab0f05030ee0451c97ba3ca5bd1e59b9
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Microbiology and Outcomes of Institutionalized Patients With Stroke-Associated Pneumonia: An Observational Cohort Study

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