AUTHOR=Zhao Jie , Li Lei-qing , Zhen Ning-xin , Du Lin-lin , Shan Hui , Yu Yang , Zhang Zhao-cai , Cui Wei , Tian Bao-ping 

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

JOURNAL=Frontiers in Microbiology

VOLUME=Volume 12 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2021.720051

DOI=10.3389/fmicb.2021.720051

ISSN=1664-302X

ABSTRACT=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 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 comprehensive analysis of symptom, imaging and laboratory results. Baseline characteristic, clinical characteristic, microbiology and outcomes were recorded and evaluated.
Results: Of 200 patients, 42.5% developed SAP after onset of stroke, and they had lower proportion of non-smoker (p=0.002), lower GCS score (p<0.001), higher serum CRP (p<0.001) at ICU admission, and 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%). Main pathogens included K. pneumoniae, S. aureus, H. influenzae, A. baumannii, P. aeruginosa, E. aerogenes, Serratia marcescens, and Burkholderia cepacia. SAP significantly prolonged length of MV (p<0.001), duration of ICU stay (p<0.001) and hospital stay (p=0.027), shorten MV-free days by 28 (p<0.001), caused elevated vasopressor application (p=0.001) and 60-day mortality (p=0.001). Logistic regression analysis suggested patients with coma (p<0.001) have higher risk of developing SAP. 
Conclusion: Microbiology of SAP is similar to early-phase HAP and VAP. SAP significantly prolongs duration of MV and length of ICU and hospital stays, but also markedly increase 60-day mortality. 
Key Words: ischemic/hemorrhagic stroke; pneumonia; microbiology; outcomes