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(Stroke. 2006;37:1656.)
© 2006 American Heart Association, Inc.

Letters to the Editor

Do We Really Understand the Pathophysiology and Clinical Impact of Poststroke Infection?

Joseph Kwan, MD, MRCP Helen C. Roberts, FRCP

Elderly Care Research Unit, Southampton General Hospital, Southampton, UK

Nicola Englyst, PhD

Endocrinology & Metabolism Unit, Southampton General Hospital, Southampton, UK

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

We read with interest the article by Vargas et al,¹ which reported the results of a prospective study of poststroke infection. Poststroke infection was found to correlate with stroke severity but not short-term outcome. There are several points about this study that require further discussion.

The authors need to clarify whether the clinical outcome was measured at hospital discharge (as mentioned in the Abstract and Table 3) or on day 7 (as mentioned in the Methods and Results sections). Clinical outcomes assessed at these 2 time-points could potentially be significantly different, especially because the median time to discharge was 9 days, and one-quarter of patients stayed for over 13 days. If outcome was indeed assessed on day 7, the authors should also explain how they handled the data for those patients who were discharged before day 7.

According to Table 1, acute bronchitis accounted for 38 of 90 (42%) poststroke infections. In contrast, pneumonia only accounted for 37% and urinary tract infections for 14%. Inclusion of acute bronchitis could potentially be problematic because of its nonspecific definition (ie, fever + bronchial secretions + leucocytosis + normal chest x-ray). Because fever, bronchial secretions and leucocytosis are all common findings after stroke, even without systemic infection, it is potentially difficult to clearly differentiate between infectious and noninfectious cases. Moreover, the systemic impact of acute bronchitis is unlikely to be as great as bacterial pneumonia.² Therefore, inclusion of acute bronchitis might have contributed to the study’s failure to find a . . . [Full Text of this Article]

Related Article:

Response to Letter by Kwan et al

Ángel Chamorro, Martha Vargas, and José Mensa
Stroke 2006 37: 1657. [Extract] [Full Text] [PDF]

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