Stroke-associated pneumonia according to mCDC criteria : impact on prognosis and antibiotic therapy
Rabaneda-Lombarte, Neus (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Faura, Júlia (Hospital Universitari Vall d'Hebron)
Ezcurra Diaz, Garbiñe (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Olivé-Gadea, Marta (Hospital Universitari Vall d'Hebron)
Álvarez-Larruy, Marta (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Vidal-de Francisco, Diana (Complejo Hospitalario de Jaén)
Domínguez-Mayoral, Ana (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Avellaneda, Carla (Hospital del Mar (Barcelona, Catalunya))
Freijo, Mari Mar (Hospital Universitario de Cruces (Barakaldo, País Basc))
Zapata-Arriaza, Elena (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Serrano-Heras, Gemma (Complejo Hospitalario Universitario de Albacete)
Alcahut-Rodríguez, Cristian (Complejo Hospitalario Universitario de Albacete)
Fernandez-Perez, Isabel (Hospital del Mar (Barcelona, Catalunya))
Moniche, Francisco (Hospital Universitario Virgen del Rocío (Sevilla, Andalusia))
Pérez-Sánchez, Soledad (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Millán, Mònica (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Rubiera, Marta (Hospital Universitari Vall d'Hebron)
Dorado Bouix, Laura (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Maisterra Santos, Olga (Hospital Universitari Vall d'Hebron)
Montaner, Joan (Hospital Universitario Virgen Macarena (Sevilla, Andalusia))
Bustamante, Alejandro (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)

Data:	2024
Resum:	Objective: The modified Centers for Disease Control and Prevention (mCDC) criteria have been proposed for diagnosing and managing stroke-associated pneumonia (SAP). The objective was to investigate the impact of SAP on stroke outcome depending on whether or not it conforms to mCDC criteria. Our secondary objective was to identify the responsible factors for antibiotic initiation in stroke patients. Methods: We conducted a prospective, multicenter, observational study of ischemic stroke patients with moderate to severe stroke (NIHSS≥4) admitted within 24 h. For 7 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. Results: Of the 342 patients studied, infections were diagnosed in 72 (21. 6%), including 39 (11. 7%) cases of pneumonia. 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, 4. 939 (1. 022-23. 868)]. The random forest analysis revealed that fever had the highest importance for antibiotic initiation. Interpretation: 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.
Ajuts:	Instituto de Salud Carlos III PI17/02130 Instituto de Salud Carlos III PI21/00949 Fundació la Marató de TV3 201706-30-31
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Antibiotics ; Infections ; Mcdc criteria ; Outcome ; Stroke-associated pneumonia
Publicat a:	Frontiers in neurology, Vol. 15 (2024) , p. 1358628, ISSN 1664-2295

DOI: 10.3389/fneur.2024.1358628
PMID: 38497035

9 p, 1.0 MB

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Documents de recerca > Documents dels grups de recerca de la UAB > Centres i grups de recerca (producció científica) > Ciències de la salut i biociències > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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