Post-stroke infection: a systematic review and meta-analysis
Willeke F. Westendorp,Paul J. Nederkoorn,Jan-Dirk Vermeij,Marcel G. W. Dijkgraaf,Diederik van de Beek +4 more
TLDR
The need to prevent infections in patients with stroke is stressed, and pneumonia was associated with death, in a systematic review and meta-analysis of studies on post-stroke infection.Abstract:
stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome. MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome. 87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU). There was significant heterogeneity between studies (P < 0.001, I2 = 97%). The overall pooled infection rate was 30% (24-36%); rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10%) and 10% (95%CI 9-12%). For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%), 28% (95%CI 18-38%) and 20% (95%CI 0-40%). Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68). Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.read more
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Factors Influencing the Decline in Stroke Mortality A Statement From the American Heart Association/American Stroke Association
Daniel T. Lackland,Edward J. Roccella,Anne Deutsch,Myriam Fornage,Mary G. George,George Howard,Brett M. Kissela,Steven J. Kittner,Judith H. Lichtman,Lynda D. Lisabeth,Lee H. Schwamm,Eric E. Smith,Amytis Towfighi +12 more
TL;DR: There is strong evidence that the decline in stroke mortality can be attributed to a combination of interventions and programs based on scientific findings and implemented with the purpose of reducing stroke risks, the most likely being improved control of hypertension.
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Stroke in the 21st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life.
TL;DR: An overview of stroke in the 21st century from a public health perspective is provided and the public health burden of stroke is set to rise over future decades because of demographic transitions of populations, particularly in developing countries.
Journal ArticleDOI
The immunology of acute stroke.
Ángel Chamorro,Andreas Meisel,Anna M. Planas,Xabier Urra,Diederik van de Beek,Roland Veltkamp +5 more
TL;DR: The multifaceted role of the immune system in the pathophysiology of acute stroke is discussed, with increased incidence of infections observed after acute stroke, and might result from activation of long-distance feedback loops between the CNS and peripheral immune organs.
Journal ArticleDOI
Stroke-Associated Pneumonia: Major Advances and Obstacles
TL;DR: The pathophysiology of SAP is likely explained by aspiration combined with stroke-induced immunodepression through complex humeral and neural pathways that include the hypothalamic-pituitary-adrenal axis, parasympathetic and sympathetic systems.
Journal ArticleDOI
Immune interventions in stroke
TL;DR: Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke and further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions.
References
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Journal ArticleDOI
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.
TL;DR: In this paper, the NHSN criteria for all healthcare-associated infections (HAIs) are presented, including those for the "Big Four" (surgical site infection [SSI], pneumonia [PNEU], bloodstream infection [BSI] and urinary tract infection [UTI]).
Journal Article
CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting.
TL;DR: In this article, the NHSN criteria for all healthcare-associated infections (HAIs) are presented, including those for the "Big Four" (surgical site infection [SSI], pneumonia [PNEU], bloodstream infection [BSI] and urinary tract infection [UTI]).
Journal ArticleDOI
The immunology of stroke: from mechanisms to translation
TL;DR: Gaining a better understanding of the reciprocal interaction between the immune system and the ischemic brain is essential to harness the full therapeutic potential of the immunology of stroke.
Journal ArticleDOI
Dysphagia After Stroke Incidence, Diagnosis, and Pulmonary Complications
Rosemary Martino,Norine Foley,Sanjit K. Bhogal,Nicholas E. Diamant,Mark Speechley,Robert Teasell +5 more
TL;DR: The high incidence for dysphagia and pneumonia is a consistent finding with stroke patients, and the pneumonia risk is greatest in stroke patients with aspiration.