AUTHOR=Rabaneda-Lombarte Neus , Faura Júlia , Ezcurra-Díaz Garbiñe , Olivé-Gadea Marta , Álvarez-Larruy Marta , Vidal-de Francisco Diana , Domínguez-Mayoral Ana , Avellaneda Carla , Freijo Mari Mar , Zapata-Arriaza Elena , Serrano-Heras Gemma , Alcahut-Rodríguez Cristian , Fernández-Pérez Isabel , Moniche Francisco , Pérez-Sánchez Soledad , Millán Mònica , Rubiera Marta , Dorado Laura , Maisterra Olga , Montaner Joan , Bustamante Alejandro 

TITLE=Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1358628

DOI=10.3389/fneur.2024.1358628

ISSN=1664-2295

ABSTRACT=The modified Centers for Disease Control and Prevention (mCDC) criteria have been proposed for diagnosing and managing stroke-associated pneumonia (SAP). We aimedThe objective was to investigate the impact of SAP on stroke outcome depending on whether or not it conforms to mCDC criteria. Our secondary aim objective was to identify the responsible factors for antibiotic initiation in stroke patients.We conducted a prospective, multicenter, observational study of ischemic stroke patients with moderate to severe stroke (NIHSS≥4) admitted within 24 hours. For seven days, mCDC criteria were assessed daily, and infections and antibiotics were recorded. Pneumonias were divided into those fulfilling mCDC criteria (mCDC-SAP) or not (other pneumonias, OPn). The effect of each type of pneumonia on 3-month outcome was evaluated in separated logistic regression models. Factors associated with antibiotic initiation were explored using a random forest analysis.From 342 patients included, infections were diagnosed in 72 (21.6%), being 39 (11.7%) pneumonias. Of them, 25 (7.5%) fulfilled mCDC criteria. Antibiotics were used in 92% of mCDC-SAP and 64.3% of OPn. In logistic regression analysis, mCDC-SAP, but not OPn, was an independent predictor of poor outcome (OR,). The random forest analysis revealed that fever had the highest importance for antibiotic initiation.The mCDC criteria might be useful for detecting clinically relevant SAP, which is associated with poor outcomes. Isolated signs of infection were more important for antibiotic initiation than compliance with pre-defined criteria. Therefore, adherence to mCDC criteria might result in antibiotic saving without compromising clinical outcome.mCDC modified Centers for Disease Control and Prevention mRS modified Rankin Scale