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Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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.
摘要：
■已经提出了用于诊断和管理卒中相关肺炎(SAP)的改良疾病控制和预防中心(mCDC)标准。目的是根据SAP是否符合mCDC标准来研究SAP对卒中结局的影响。我们的次要目标是确定中风患者开始使用抗生素的相关因素。
■我们进行了前瞻性，多中心，24小时内收治的中度至重度卒中（NIHSS≥4）的缺血性卒中患者的观察性研究。每天评估mCDC标准，记录感染和抗生素。肺炎分为符合mCDC标准(mCDC-SAP)或不符合mCDC标准(其他肺炎，OPn).在单独的逻辑回归模型中评估每种类型的肺炎对3个月预后的影响。使用随机森林分析探索与抗生素启动相关的因素。
■在研究的342名患者中，72例(21.6%)被诊断出感染，包括39例(11.7%)肺炎病例。其中,25（7.5%）符合mCDC标准。在92%的mCDC-SAP和64.3%的OPn中使用抗生素。在逻辑回归分析中，mCDC-SAP,但不是OPN,是不良结局的独立预测因子[OR，4.939(1.022-23.868)]。随机森林分析显示，发烧对抗生素启动的重要性最高。
■mCDC标准可能对检测临床相关SAP有用，这与糟糕的结果有关。对于抗生素启动，孤立的感染迹象比遵守预定义标准更为重要。因此,坚持mCDC标准可能导致抗生素节约,而不影响临床结局.
■我们进行了前瞻性，多中心，24小时内收治的中度至重度卒中（NIHSS≥4）的缺血性卒中患者的观察性研究。每天评估mCDC标准，记录感染和抗生素。肺炎分为符合mCDC标准(mCDC-SAP)或不符合mCDC标准(其他肺炎，OPn).在单独的逻辑回归模型中评估每种类型的肺炎对3个月预后的影响。使用随机森林分析探索与抗生素启动相关的因素。
■在研究的342名患者中，72例(21.6%)被诊断出感染，包括39例(11.7%)肺炎病例。其中,25（7.5%）符合mCDC标准。在92%的mCDC-SAP和64.3%的OPn中使用抗生素。在逻辑回归分析中，mCDC-SAP,但不是OPN,是不良结局的独立预测因子[OR，4.939(1.022-23.868)]。随机森林分析显示，发烧对抗生素启动的重要性最高。
■mCDC标准可能对检测临床相关SAP有用，这与糟糕的结果有关。对于抗生素启动，孤立的感染迹象比遵守预定义标准更为重要。因此,坚持mCDC标准可能导致抗生素节约,而不影响临床结局.
