Microbiological etiologies of pneumonia complicating stroke: a systematic review

Kishore, A. K. et al. (2018) Microbiological etiologies of pneumonia complicating stroke: a systematic review. Stroke, 49(7), pp. 1602-1609. (doi: 10.1161/STROKEAHA.117.020250) (PMID:29915122)

Abstract

Background and Purpose: Identifying the causal pathogens of pneumonia complicating stroke is challenging, and antibiotics used are often broad spectrum, without recourse to the microbiological cause. We aimed to review existing literature to identify organisms responsible for pneumonia complicating stroke, before developing a consensus-based approach to antibiotic treatment. Methods: A systematic literature review of multiple electronic databases using predefined search criteria was undertaken, in accordance with Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Published studies of hospitalized adults with ischemic stroke, intracerebral hemorrhage, or both, which identified microbiological etiologies for pneumonia complicating stroke up to January 1, 2017, were considered. Analysis included summary statistics and random-effects meta-analysis where appropriate. Results: Fifteen studies (40% ischemic stroke, 60% ischemic stroke and intracerebral hemorrhage) involving 7968 patients were included. Reported occurrence of pneumonia varied considerably between studies (2%–63%) with a pooled frequency of 23% (95% confidence interval, 14%–34%; I2=99%). Where reported (60%), the majority of pneumonia occurred within 1 week of stroke (78%). Reported frequency of positive culture data (15%–88%) varied widely. When isolated, aerobic Gram-negative bacilli (38%) and Gram-positive cocci (16%) were most frequently cultured; commonly isolated organisms included Enterobacteriaceae (21.8%: Klebsiella pneumoniae, 12.8% and Escherichia coli, 9%), Staphylococcus aureus (10.1%), Pseudomonas aeruginosa (6%), Acinetobacter baumanii (4.6%), and Streptococcus pneumoniae (3.5%). Sputum was most commonly used to identify pathogens, in isolation (40%) or in conjunction with tracheal aspirate (15%) or blood culture (20%). Conclusions: Although the analysis was limited by small and heterogeneous study populations, limiting determination of microbiological causality, this review suggests aerobic Gram-negative bacilli and Gram-positive cocci are frequently associated with pneumonia complicating stroke. This supports the need for appropriately designed studies to determine microbial cause and a consensus-based approach in antibiotic usage and further targeted antibiotic treatment trials for enhanced antibiotic stewardship.

• Item Type: Articles
• Additional Information: Dr Meisel is supported by the German Research Foundation (EXC257 and SFB-TR84).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Langhorne, Professor Peter
• Authors: Kishore, A. K., Vail, A., Jeans, A. R., Chamorro, A., Di Napoli, M., Kalra, L., Langhorne, P., Roffe, C., Westendorp, W., Nederkoorn, P. J., Garau, J., van de Beek, D., Montaner, J., Woodhead, M., Meisel, A., and Smith, C. J.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Stroke
• Publisher: American Heart Association
• ISSN: 0039-2499
• ISSN (Online): 1524-4628
• Published Online: 18 June 2018
• Copyright Holders: Copyright © 2018 American Heart Association, Inc.
• First Published: First published in Stroke 49(7):1602-1609
• Publisher Policy: Reproduced in accordance with the publisher copyright policy