Pathogen colonization in patients with acute cerebral stroke

Abstract

Purpose: To identify the pathogens that frequently cause infection and to explore their clinical features in acute stroke patients. Methods: From June 1, 1999 to December 31, 2008, we reviewed medical records of 263 patients with acute stroke and 351 controls. Within 30 days from admission, 109 and 107 patients had one or more bacterial cultures, respectively. The cumulative bacteria-free probability of all patients and the incidence of each isolated pathogen were assessed. We searched for the factors associated with isolation of different Gram-negative bacilli (GNB). Results: Patients with recent stroke were prone to healthcare-associated colonization within 2 weeks from admission. One-fourth of stroke patients had positive bacterial culture. Stroke patients had a high incidence of Staphylococcus aureus and various GNB in their sputum. When urinary tract infections (UTIs) began 9 days or more after admission, the contributory pathogens were most often glucose-nonfermenting bacilli. However, if UTIs occurred within 9 days after admission, the pathogens were likely to be Enterobacteriaceae bacilli. Conclusions: Stroke patients had high incidence of pathogenic bacteria in their sputum which might be prone to pneumonia. The time after admission of the onset of UTI is useful information for predicting contributory pathogens and planning for appropriate treatment.

Implications for Rehabilitation

• Special care should be taken for reducing healthcare-associated pathogenic colonization within the first 2 weeks of hospitalization after stroke.

• Good oral hygiene to decrease the colonization of Staphylococcus aureus and various Gram-negative bacilli in sputum is important for pneumonia prevention in stroke patients.

• Stroke patients suspected of having urinary tract infections 9 days or more after admission are likely infected with glucose-nonfermenting bacilli, whereas many isolates from the earlier cultures are Enterobacteriaceae bacilli. Accordingly, physicians can start empirical treatment early.

Keywords::

• Bacteria
• pneumonia
• stroke
• urinary tract infections

Acknowledgements

Prof. Winston W. Shen gave editing comments in an earlier version of this manuscript.

Declaration of Interest: This study was supported by grant 101-wf-eva-12 from Wan Fang Hospital, Taipei Medical University and grant DOH101-TD-B-111-003 from the Center of Excellence for Clinical Trials and Research in Neuroscience, Department of Health, Executive Yuan, Taiwan. The authors report no conflicts of interest.