BACKGROUND: Stroke-associated pneumonia (SAP) is associated with impaired outcome in acute stroke patients. Current European and American guidelines for acute stroke care are lacking standardised recommendations for the management of SAP. We investigated current diagnostic and treatment practice for SAP in German stroke units (SU). METHODS: We developed a standardised questionnaire including characteristics of SU, questions related to antibiotic treatment approaches of SAP and five case vignettes describing relevant clinical scenarios based on Centers for Disease Control and Prevention (CDC) criteria for 'clinically defined pneumonia'. All certified German SU were invited to take part in the survey. RESULTS: The survey took place from April to August 2010. Of all 162 German SU contacted, 83 (51%) responded. Classification and regression trees analysis suggested that SAP was diagnosed on the basis of clinical criteria such as fever and stroke severity. Chest x-ray showed only limited influence on the diagnosis of SAP. C-reactive protein was frequently requested as additional diagnostic information (38-76%). Group 3 cephalosporines and (acyl-) aminopenicillins/β-lactamase inhibitors are the most frequently used antibiotics (46-60%) in empiric mono (58%) and combination (42%) therapy. A minority of SU (5%) use prophylactic antibiotic treatment. Standardised procedures are available in 61% of SU. CONCLUSION: Clinical criteria were the main determinants for SAP diagnosis. In contrast, chest x-ray--the central diagnostic item in CDC criteria--was of minor importance. Our survey demonstrates heterogeneous diagnostic and therapeutic strategies in German SU. Future studies need to establish and to evaluate standardised criteria for SAP care.
BACKGROUND:Stroke-associated pneumonia (SAP) is associated with impaired outcome in acute strokepatients. Current European and American guidelines for acute stroke care are lacking standardised recommendations for the management of SAP. We investigated current diagnostic and treatment practice for SAP in German stroke units (SU). METHODS: We developed a standardised questionnaire including characteristics of SU, questions related to antibiotic treatment approaches of SAP and five case vignettes describing relevant clinical scenarios based on Centers for Disease Control and Prevention (CDC) criteria for 'clinically defined pneumonia'. All certified German SU were invited to take part in the survey. RESULTS: The survey took place from April to August 2010. Of all 162 German SU contacted, 83 (51%) responded. Classification and regression trees analysis suggested that SAP was diagnosed on the basis of clinical criteria such as fever and stroke severity. Chest x-ray showed only limited influence on the diagnosis of SAP. C-reactive protein was frequently requested as additional diagnostic information (38-76%). Group 3 cephalosporines and (acyl-) aminopenicillins/β-lactamase inhibitors are the most frequently used antibiotics (46-60%) in empiric mono (58%) and combination (42%) therapy. A minority of SU (5%) use prophylactic antibiotic treatment. Standardised procedures are available in 61% of SU. CONCLUSION: Clinical criteria were the main determinants for SAP diagnosis. In contrast, chest x-ray--the central diagnostic item in CDC criteria--was of minor importance. Our survey demonstrates heterogeneous diagnostic and therapeutic strategies in German SU. Future studies need to establish and to evaluate standardised criteria for SAP care.
Authors: Sarah Hoffmann; Hendrik Harms; Lena Ulm; Darius G Nabavi; Bruno-Marcel Mackert; Ingo Schmehl; Gerhard J Jungehulsing; Joan Montaner; Alejandro Bustamante; Marcella Hermans; Frank Hamilton; Jos Göhler; Uwe Malzahn; Carolin Malsch; Peter U Heuschmann; Christian Meisel; Andreas Meisel Journal: J Cereb Blood Flow Metab Date: 2016-10-14 Impact factor: 6.200
Authors: Amit K Kishore; Andy Vail; Benjamin D Bray; Angel Chamorro; Mario Di Napoli; Lalit Kalra; Peter Langhorne; Joan Montaner; Christine Roffe; Anthony G Rudd; Pippa J Tyrrell; Diederik van de Beek; Mark Woodhead; Andreas Meisel; Craig J Smith Journal: Eur Stroke J Date: 2016-06-01
Authors: Craig J Smith; Benjamin D Bray; Alex Hoffman; Andreas Meisel; Peter U Heuschmann; Charles D A Wolfe; Pippa J Tyrrell; Anthony G Rudd Journal: J Am Heart Assoc Date: 2015-01-13 Impact factor: 5.501
Authors: Amit K Kishore; Adam R Jeans; Javier Garau; Alejandro Bustamante; Lalit Kalra; Peter Langhorne; Angel Chamorro; Xabier Urra; Mira Katan; Mario Di Napoli; Willeke Westendorp; Paul J Nederkoorn; Diederik van de Beek; Christine Roffe; Mark Woodhead; Joan Montaner; Andreas Meisel; Craig J Smith Journal: Eur Stroke J Date: 2019-05-27