Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy
ObjectiveThe 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 second...
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Frontiers Media S.A.
2024-02-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2024.1358628/full |
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| author | Neus Rabaneda-Lombarte Júlia Faura Garbiñe Ezcurra-Díaz Marta Olivé-Gadea Marta Álvarez-Larruy Diana Vidal-de Francisco Ana Domínguez-Mayoral Carla Avellaneda Mari Mar Freijo Elena Zapata-Arriaza Gemma Serrano-Heras Cristian Alcahut-Rodríguez Isabel Fernández-Pérez Francisco Moniche Soledad Pérez-Sánchez Mònica Millán Marta Rubiera Laura Dorado Olga Maisterra Joan Montaner Joan Montaner Alejandro Bustamante |
| author_facet | Neus Rabaneda-Lombarte Júlia Faura Garbiñe Ezcurra-Díaz Marta Olivé-Gadea Marta Álvarez-Larruy Diana Vidal-de Francisco Ana Domínguez-Mayoral Carla Avellaneda Mari Mar Freijo Elena Zapata-Arriaza Gemma Serrano-Heras Cristian Alcahut-Rodríguez Isabel Fernández-Pérez Francisco Moniche Soledad Pérez-Sánchez Mònica Millán Marta Rubiera Laura Dorado Olga Maisterra Joan Montaner Joan Montaner Alejandro Bustamante |
| author_sort | Neus Rabaneda-Lombarte |
| collection | DOAJ |
| description | ObjectiveThe 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.MethodsWe 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.ResultsOf 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.InterpretationThe 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. |
| first_indexed | 2024-03-07T19:00:52Z |
| format | Article |
| id | doaj.art-ab3af89fe9624da79d519d4774b29ef8 |
| institution | Directory Open Access Journal |
| issn | 1664-2295 |
| language | English |
| last_indexed | 2024-03-07T19:00:52Z |
| publishDate | 2024-02-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Neurology |
| spelling | doaj.art-ab3af89fe9624da79d519d4774b29ef82024-03-01T14:41:04ZengFrontiers Media S.A.Frontiers in Neurology1664-22952024-02-011510.3389/fneur.2024.13586281358628Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapyNeus Rabaneda-Lombarte0Júlia Faura1Garbiñe Ezcurra-Díaz2Marta Olivé-Gadea3Marta Álvarez-Larruy4Diana Vidal-de Francisco5Ana Domínguez-Mayoral6Carla Avellaneda7Mari Mar Freijo8Elena Zapata-Arriaza9Gemma Serrano-Heras10Cristian Alcahut-Rodríguez11Isabel Fernández-Pérez12Francisco Moniche13Soledad Pérez-Sánchez14Mònica Millán15Marta Rubiera16Laura Dorado17Olga Maisterra18Joan Montaner19Joan Montaner20Alejandro Bustamante21Hospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, SpainVall d'Hebrón Institute of Research, Barcelona, SpainHospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, SpainHospital Universitari Vall d’Hebrón, Barcelona, SpainHospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, SpainComplejo Hospitalario de Jaén, Jaén, SpainHospital Universitario Virgen Macarena, Sevilla, SpainHospital del Mar, Barcelona, SpainHospital Universitario Cruces, Barakaldo, SpainHospital Universitario Virgen del Rocío, Sevilla, SpainComplejo Hospitalario Universitario de Albacete, Albacete, SpainComplejo Hospitalario Universitario de Albacete, Albacete, SpainHospital del Mar, Barcelona, SpainHospital Universitario Virgen del Rocío, Sevilla, SpainHospital Universitario Virgen Macarena, Sevilla, SpainHospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, SpainHospital Universitari Vall d’Hebrón, Barcelona, SpainHospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, SpainHospital Universitari Vall d’Hebrón, Barcelona, SpainVall d'Hebrón Institute of Research, Barcelona, SpainHospital Universitario Virgen Macarena, Sevilla, SpainHospital Universitari and Institut de Recerca Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, SpainObjectiveThe 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.MethodsWe 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.ResultsOf 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.InterpretationThe 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.https://www.frontiersin.org/articles/10.3389/fneur.2024.1358628/fullantibioticsinfectionsmCDC criteriaoutcomestroke-associated pneumonia |
| spellingShingle | Neus Rabaneda-Lombarte Júlia Faura Garbiñe Ezcurra-Díaz Marta Olivé-Gadea Marta Álvarez-Larruy Diana Vidal-de Francisco Ana Domínguez-Mayoral Carla Avellaneda Mari Mar Freijo Elena Zapata-Arriaza Gemma Serrano-Heras Cristian Alcahut-Rodríguez Isabel Fernández-Pérez Francisco Moniche Soledad Pérez-Sánchez Mònica Millán Marta Rubiera Laura Dorado Olga Maisterra Joan Montaner Joan Montaner Alejandro Bustamante Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy Frontiers in Neurology antibiotics infections mCDC criteria outcome stroke-associated pneumonia |
| title | Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy |
| title_full | Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy |
| title_fullStr | Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy |
| title_full_unstemmed | Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy |
| title_short | Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy |
| title_sort | stroke associated pneumonia according to mcdc criteria impact on prognosis and antibiotic therapy |
| topic | antibiotics infections mCDC criteria outcome stroke-associated pneumonia |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2024.1358628/full |
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