Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy

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• dc.contributor.author Rabaneda-Lombarte, Neus
• dc.contributor.author Avellaneda Gómez, Carla
• dc.contributor.author Fernández-Pérez, Isabel
• dc.contributor.author Bustamante, Alejandro
• dc.date.accessioned 2025-05-27T06:29:43Z
• dc.date.available 2025-05-27T06:29:43Z
• dc.date.issued 2024
• dc.description.abstract 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: Of 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. 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Rabaneda-Lombarte N, Faura J, Ezcurra-Díaz G, Olivé-Gadea M, Álvarez-Larruy M, Vidal-de Francisco D, et al. Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy. Front Neurol. 2024 Feb 28;15:1358628. DOI: 10.3389/fneur.2024.1358628
• dc.identifier.doi http://dx.doi.org/10.3389/fneur.2024.1358628
• dc.identifier.issn 1664-2295
• dc.identifier.uri http://hdl.handle.net/10230/70518
• dc.language.iso eng
• dc.publisher Frontiers
• dc.relation.ispartof Front Neurol. 2024 Feb 28;15:1358628
• dc.rights © 2024 Rabaneda-Lombarte, Faura, Ezcurra-Díaz, Olivé-Gadea, Álvarez-Larruy, Vidal-de Francisco, Domínguez-Mayoral, Avellaneda, Freijo, Zapata-Arriaza, Serrano-Heras, Alcahut-Rodríguez, Fernández-Pérez, Moniche, Pérez-Sánchez, Millán, Rubiera, Dorado, Maisterra, Montaner and Bustamante. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. http://creativecommons.org/licenses/by/4.0/
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Antibiotics
• dc.subject.keyword Infections
• dc.subject.keyword mCDC criteria
• dc.subject.keyword Outcome
• dc.subject.keyword Stroke-associated pneumonia
• dc.title Stroke-associated pneumonia according to mCDC criteria: impact on prognosis and antibiotic therapy
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion