Acute Ischemic Stroke and Infections

Ionita, Catalina C.; Siddiqui, Adnan H.; Levy, Elad I.; Hopkins, L. Nelson; Snyder, Kenneth V.; Gibbons, Kevin J.

doi:10.1016/j.jstrokecerebrovasdis.2009.09.011

Cited by 56 publications

(48 citation statements)

References 77 publications

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“…Poststroke pneumonia may result from aspiration caused by impaired consciousness or reduced bulbar reflexes with consecutive oropharyngeal dysphagia, as well as from invasive measures such as feeding tube placement or orotracheal intubation and mechanical ventilation. 2 However, aspiration and specific neurological impairments alone do not completely explain the high incidence of poststroke infections. 3 There is increasing evidence that brain-immune interactions become dysregulated after stroke, resulting in a stroke-related immunosuppression syndrome.…”

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confidence: 99%

Autonomic Shift and Increased Susceptibility to Infections After Acute Intracerebral Hemorrhage

Sýkora

Diedler

Poli

et al. 2011

Stroke

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Background and Purpose-High infection rate after severe stroke may partly relate to brain-induced immunodepression syndrome. However, the underlying pathophysiology remains unclear. The aim of the current study was to investigate the role of autonomic shift in increased susceptibility to infection after acute intracerebral hemorrhage (ICH). Methods-We retrospectively analyzed 62 selected patients with acute ICH from our prospective database. Autonomic shift was assessed using the cross-correlational baroreflex sensitivity (BRS). The occurrence and cause of in-hospital infections were assessed based on the clinical and laboratory courses. Demographic and clinical data including initial stroke severity, hemorrhage volume, intraventricular blood extension, history of aspiration, and invasive procedures such as mechanical ventilation, surgical hematoma evacuation, external ventricular drainage, central venous and urinary catheters, and nasogastric feeding were recorded and included in the analysis. Results-We identified 36 (58%) patients with infection during the first 5 days of hospital stay. Patients with infections had significantly lower BRS, higher initial NIHSS scores, larger hemorrhages, and more frequently had intraventricular blood extension and underwent invasive procedures. In the multivariate regression model, decreased BRS (OR, 0.54; 95% CI, 0.32-0.91; Pϭ0.02) and invasive procedures (OR, 2.32; 95% CI, 1.5-3.6; PϽ0.001) remained independent predictors for an infection after ICH. Conclusions-Decreased BRS was independently associated with infections after ICH. Autonomic shift may play an important role in increased susceptibility to infections after acute brain injury including ICH. The possible therapeutic relevance of autonomic modulation warrants further studies. (Stroke. 2011;42:1218-1223.)

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mentioning

confidence: 99%

Autonomic Shift and Increased Susceptibility to Infections After Acute Intracerebral Hemorrhage

Sýkora

Diedler

Poli

et al. 2011

Stroke

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“…As taxas podem variar de acordo com as características da população estudada e do local de atendimento. Entre as infecções, as mais frequentemente descritas são as de origem respiratória, variando de 7,5% a 19,9%, e a infecção urinária, com prevalência entre 4,4% e 10% [22][23][24][25].…”

Section: Discussionunclassified

“…Tanto infecções podem precipitar o AVC [27] como podem ocorrer após o agravo vascular cerebral [22]. Além do estado de imobilidade e restrição física que o AVC moderado a severo frequentemente impõe, há necessidade de hospitalização dos casos graves, por vezes prolongada, inserção de múltiplos cateteres e sondas e eventual necessidade de suporte respiratório invasivo e internação em UTI [28].…”

Section: Discussionunclassified

Gravidade do déficit neurológico e incidência de infecções hospitalares em pacientes idosos com acidente vascular cerebral agudo

Conterno

Barbosa

Rego

et al. 2016

Sci Med

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. (13,5%). O tempo médio de permanência hospitalar dos pacientes com infecção hospitalar foi maior, quando comparados àqueles sem infecção hospitalar (16,2±16,2 dias e 33,2±22,9 dias, p<0,001). Observou-se relação entre escore de 16 a 42 pontos, na National Institute of Health Stroke Scale, e a ocorrência de infecção hospitalar (rico relativo 4,4; intervalo de confiança 95% 1,8 a 11,0). A mortalidade intra-hospitalar foi de 15,9%, sendo maior entre pacientes considerados muito graves à admissão, quando comparados com aqueles com gravidade moderada a leve pela National Institute of Health Stroke Scale, (34,6% e 1,6% respectivamente, p<0,001) e também entre aqueles que desenvolveram infecção hospitalar quando comparados aos que não apresentaram esta complicação (37,5% e 10,1% respectivamente, p=0,003). Conclusões: As infecções hospitalares foram complicações importantes entre os pacientes idosos com acidente vascular cerebral agudo e estiveram associadas com maior gravidade do déficit neurológico, maior grau de dependência, tempo de hospitalização mais prolongado e taxa de mortalidade mais alta. DESCRITORES: acidente vascular cerebral; infecção hospitalar; epidemiologia; mortalidade; idosos. ABSTRACT Aims:To evaluate the association between severity of neurological deficit/degree of functional disability and incidence of nosocomial infections, length of hospital stay, and mortality, in elderly patients with acute stroke. Methods: A prospective cohort study evaluated elderly patients with acute stroke, hospitalized at the Hospital of the Marilia Medical School, in Marilia, SP, Brazil. Inclusion criteria were patients aged 60 years or more and diagnosed with acute stroke. Patients were stratified according to the severity of the stroke by the National Institutes of Health Stroke Scale and the degree of dependence by the modified Rankin scale. All patients were followed from the time of admission to discharge or death. Results: We studied 113 patients with a mean age of 70.8 years, 63 (55.7%) men. The main underlying diseases were hypertension (77.9%) and type 2 diabetes mellitus (30.1%). Seventy-eight (69%) patients were affected for the first time and 86 (76.1%) had ischemic stroke. Nosocomial infection occurred in 24 patients (21.2%) and pneumonia was the most frequent (13.5%). The average length of hospital stay among patients with nosocomial infection was higher when compared to those without nosocomial infection (16.2±16.2 days and 33.2±22.9 days, p<0.001). There was association between score 16-42 points on the National Institute of Health Stroke Scale and the occurrence of nosocomial infection (risk ratio 4.4; 95% confidence interval 1.8 to 11.0). In-hospital mortality was 15.9%, higher among patients considered severe at admission compared to those with moderate to mild severity by t...

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“…Studies regarding the effects of infection on worsening stroke symptoms have yielded ambiguous results [14]. While several studies could not demonstrate an independent association between infection and worsening of neurological deficit after stroke [15][16][17], the majority of studies showed that infections in hospitalized patients in the acute phase after stroke are associated with a worse functional outcome and increased mortality [6,[18][19][20]. In the largest study, Katzan et al [21] described a 30-day mortality of 27 % after poststroke pneumonia compared with a mortality rate of 4 % in patients without pneumonia.…”

Section: Rationale Behind Prophylactic Antibiotic Therapy In Strokementioning

confidence: 99%

“…Various risk factors for infection after stroke such as severe neurological deficit at presentation, bedridden state, older age, and dysphagia have been described [6,20].…”

Section: Rationale Behind Prophylactic Antibiotic Therapy In Strokementioning

confidence: 99%

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

Schwarz

2016

Neurotherapeutics

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Infections, in particular pneumonia, are common complications in patients with acute stroke and are associated with a less favorable neurologic and functional outcome. Patients with severe stroke and dysphagia are at highest risk of infection. Experimental and clinical data suggest stroke-induced immunodeficiency as a major factor contributing to the high incidence of infection after stroke. Preclinical studies support the potential benefit of preventive antibiotic therapy in acute stroke for lowering the incidence of infection and improving clinical outcome. Several smaller clinical trials on preventive antibiotic therapy in patients with stroke conducted during the last 10 years yielded inconclusive results. Recently, 2 large, open-label, controlled trials failed to demonstrate an improved clinical outcome after preventive antibiotic therapy in patients with acute stroke treated in specialized stroke units. In the BPreventive Antibiotics in Stroke Study^, antibiotic therapy lowered the rate of infection but did not influence outcome. In the STROKE-INF study, performed in patients with dysphagia after stroke, antibiotic therapy did not lower the incidence of pneumonia and had no prognostic significance. At present, preventive antibiotic therapy cannot be recommended as a therapeutic option for acute stroke.

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Acute Ischemic Stroke and Infections

Cited by 56 publications

References 77 publications

Autonomic Shift and Increased Susceptibility to Infections After Acute Intracerebral Hemorrhage

Autonomic Shift and Increased Susceptibility to Infections After Acute Intracerebral Hemorrhage

Gravidade do déficit neurológico e incidência de infecções hospitalares em pacientes idosos com acidente vascular cerebral agudo

Prophylactic Antibiotic Therapy for Preventing Poststroke Infection

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