Data_Sheet_1_Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy.docx (2.3 MB)

Data_Sheet_1_Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy.docx

dataset

posted on 2024-02-28, 04:31 authored by 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, Alejandro Bustamante

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

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, 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.