A Simple Prediction Score for Developing a Hospital-Acquired Infection after Acute Ischemic Stroke

Abstract

Background Hospital-acquired infections are a major cause of morbidity and mortality in acute ischemic stroke patients. While prior scoring systems have been developed to predict pneumonia in ischemic stroke patients, these scores were not designed to predict other infections. We sought to develop a simple scoring system for any hospital-acquired infection. Methods Patients admitted to our stroke center (07/08-06/12) were retrospectively assessed. Patients were excluded if they had an in-hospital stroke, unknown time from symptom onset, or delay from symptom onset to hospital arrival >48 hours. Infections were diagnosed via clinical, laboratory, and imaging modalities using standard definitions. A scoring system was created to predict infections based on baseline patient characteristics. Results Of 568 patients, 84 (14.8%) developed an infection during their stays. Patients who developed infection were older (73 vs. 64, p<0.0001), more frequently diabetic (43.9% vs. 29.1%, p=0.0077), and had more severe strokes on admission (National Institutes of Health Stroke Scale 12 vs. 5, p<0.0001). Ranging from 0-7, the overall infection score consists of age ≥ 70 (1 point), history of diabetes (1 point), and National Institutes of Health Stroke Scale (0-4 conferred 0 points, 5-15 3 points, >15 5 points). Patients with an infection score of ≥4 were at 5 times greater odds of developing an infection (OR 5.67, 95% CI 3.28-9.81, p<0.0001). Conclusion In our sample, clinical, laboratory, and imaging information available at admission identified patients at risk for infections during their acute hospitalizations. If validated in other populations, this score could assist providers in predicting infections after ischemic stroke.

Excessive antibiotics use increased in-hospital mortality in intracerebral hemorrhage patients with stroke-associated infection

“…This indicates that the severity of neurological deficits is closely related to the use of antibiotics: the loss of swallowing function 26 , hypostatic pneumonia caused by impairment of physical activity, and aspiration or reflux caused by disturbance of consciousness 27 may lead to infection, in turn www.nature.com/scientificreports www.nature.com/scientificreports/ increasing PAUD. Our findings support previous results linking NIHSS score to the developed infection of patients with stroke 28 , which may help explain the observed association between high PAUD and in-hospital mortality. However, we did not observe an association of hematoma volume or GCS score with PAUD, although both factors are closely related to the occurrence of SAI after intracerebral hemorrhage [29][30][31] .…”

Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke

“…One prior retrospective study reviewed 568 admissions for AIS to develop a scoring system to predict the likelihood of post-stroke infection. They identified age, diabetes, and stroke severity as predictors of infection, while sex was not found to be predictive of this outcome (8). Rodent studies have shown sexual dimorphisms in functional outcomes and inflammatory response after experimental brain ischemia suggesting that post-stroke infectious complications may also be sex dependent (9).…”

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

“…The frequency of infection in patients with acute stroke has been the subject of numerous clinical studies. Owing to different designs, patient selection criteria, diagnostic criteria, timing of assessment, and duration of follow-up, the results vary considerably, with a reported incidence of infection up to 90 % [9][10][11][12][13]. Almost all studies described pneumonia as the most frequent type of infection after stroke, followed by urinary tract infection [6].…”