Published Online
on March 13, 2003

A more recent version of this article appeared on April 1, 2003

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Submitted on October 18, 2002
Accepted on November 4, 2002

Nosocomial Pneumonia After Acute Stroke. Implications for Neurological Intensive Care Medicine

Ruediger Hilker MD; Carsten Poetter MD; Nahide Findeisen MD; Jan Sobesky MD; Andreas Jacobs MD; Michael Neveling MD; and Wolf-Dieter Heiss MD^*

From the Departments of Neurology (R.H., N.T., J.S., A.J., M.N., W.-D.H.) and Hospital Infection Control (C.P.), University Hospital, Cologne, Germany.

^* To whom correspondence should be addressed. E-mail: wdh{at}pet.mpin-koeln.mpg.de.

Background and Purpose--Pneumonia has been estimated to occur in about one third of patients after acute stroke. Only limited data are available on stroke-associated pneumonia (SAP) in specialized neurological intensive care units (NICUs).

Methods--We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospective observational study. Incidence rates and risk factors of SAP and long-term clinical outcome were determined.

Results--SAP incidence was 21% with a spectrum of pathogens, which is comparable to previously published data on general ICU patients. Mechanical ventilation, multiple location, and vertebrobasilar stroke, as well as dysphagia and abnormal chest x-ray findings, were identified as risk factors for the disease. SAP patients showed higher mortality rates than nondiseased subjects (acute, 26.9% versus 8.2%; long-term, 35.3% versus 14.3%) and a significantly poorer long-term clinical outcome (Barthel Index, 50.5±42.4 versus 81.5±27.8; Rankin Scale, 3.5±1.7 versus 2.2±1.6).

Conclusions--Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting. They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients. Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising.

Key words: intensive care units • pneumonia • stroke

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