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Published in: Current Neurology and Neuroscience Reports 9/2016

01-09-2016 | Infection (J Halperin, Section Editor)

Impact of Infection on Stroke Morbidity and Outcomes

Authors: Chad M. Miller, Réza Behrouz

Published in: Current Neurology and Neuroscience Reports | Issue 9/2016

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Abstract

Each year, millions of persons worldwide are disabled by stroke. The burden of stroke is expected to increase as a consequence of growth in our elderly population. Outcome is dependent upon limitation of secondary medical processes in the acute setting that lead to deterioration and increased long-term disability. The prevalence of infection after stroke is greater that seen in other medical conditions with similar acuity and its impact upon morbidity and mortality is substantial. Physical impairment and immune modulation are chief determinants in rate of infection after stroke. Each of these factors has been a target for therapeutic intervention. Current best practices for acute stroke management implement strategies for prevention, prompt identification, and treatment of infection. Novel therapies are currently being explored which have the opportunity to greatly minimize infectious complications following stroke. Fever commonly accompanies infection and independently influences stroke outcome. Targeted temperature management provides an additional chance to improve stroke recovery.
Literature
1.
go back to reference Shim R, Wong CH. Ischemia, immunosuppression and infection, tackling the predicaments of post-stroke complications. Int J Mol Sci. 2016;17:64.CrossRefPubMedCentral Shim R, Wong CH. Ischemia, immunosuppression and infection, tackling the predicaments of post-stroke complications. Int J Mol Sci. 2016;17:64.CrossRefPubMedCentral
2.
go back to reference Yeh SJ, Huang KY, Wang TG, et al. Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. J Neurol Sci. 2011;306:38–41.CrossRefPubMed Yeh SJ, Huang KY, Wang TG, et al. Dysphagia screening decreases pneumonia in acute stroke patients admitted to the stroke intensive care unit. J Neurol Sci. 2011;306:38–41.CrossRefPubMed
3.
go back to reference Bustamante A, Garcia-Berrocoso T, Rodriguez N, et al. Ischemic stroke outcome: a review of the influence of post-stroke complications within the different scenarios of stroke care. Eur J Int Med. 2016;29:9–21.CrossRef Bustamante A, Garcia-Berrocoso T, Rodriguez N, et al. Ischemic stroke outcome: a review of the influence of post-stroke complications within the different scenarios of stroke care. Eur J Int Med. 2016;29:9–21.CrossRef
4.
go back to reference Friedant A, Gouse BM, Boehme A, et al. A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015;34(3):680–6.CrossRef Friedant A, Gouse BM, Boehme A, et al. A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke. J Stroke Cerebrovasc Dis. 2015;34(3):680–6.CrossRef
5.
go back to reference Teramoto S. Novel preventive and therapeutic strategy for post-stroke pneumonia. Expert Rev Neurother. 2009;9:1187–200.CrossRefPubMed Teramoto S. Novel preventive and therapeutic strategy for post-stroke pneumonia. Expert Rev Neurother. 2009;9:1187–200.CrossRefPubMed
6.
go back to reference Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Respiratory infections in acute stroke: nasogastric tubes and immobility are stronger predictors than dysphagia. Dysphagia. 2014;29:340–5.CrossRefPubMed Brogan E, Langdon C, Brookes K, Budgeon C, Blacker D. Respiratory infections in acute stroke: nasogastric tubes and immobility are stronger predictors than dysphagia. Dysphagia. 2014;29:340–5.CrossRefPubMed
7.
8.
go back to reference Prass K, Braun JS, Dirnagl U, Meisel C, Meisel A. Stroke propagates bacterial aspiration to pneumonia in a model of cerebral ischemia. Stroke. 2006;37:2607–12.CrossRefPubMed Prass K, Braun JS, Dirnagl U, Meisel C, Meisel A. Stroke propagates bacterial aspiration to pneumonia in a model of cerebral ischemia. Stroke. 2006;37:2607–12.CrossRefPubMed
9.
10.
go back to reference Doll DN, Engler-Chiurazzi BE, Lewis SE, et al. Lipopolysaccharide exacerbates infarct size and results in worse post-stroke behavioral outcomes. Behav Brain Funct. 2015;11:32.CrossRefPubMedPubMedCentral Doll DN, Engler-Chiurazzi BE, Lewis SE, et al. Lipopolysaccharide exacerbates infarct size and results in worse post-stroke behavioral outcomes. Behav Brain Funct. 2015;11:32.CrossRefPubMedPubMedCentral
11.
go back to reference Kenes A, Pradillo JM, Drake C, et al. Streptococcus pneumonia worsens cerebral ischemia via interleukin 1 and platelet glycoprotein Ibα. Ann Neurol. 2014;75:670–83.CrossRef Kenes A, Pradillo JM, Drake C, et al. Streptococcus pneumonia worsens cerebral ischemia via interleukin 1 and platelet glycoprotein Ibα. Ann Neurol. 2014;75:670–83.CrossRef
12.
go back to reference Offner H, Subramanian S, Parker SM, Afentoulis ME, Vandenbark AA, Hurn PD. Experimental stroke induces massive, rapid activation of the peripheral immune system. J Cereb Blood Flow Metab. 2006;26:654–5.CrossRefPubMed Offner H, Subramanian S, Parker SM, Afentoulis ME, Vandenbark AA, Hurn PD. Experimental stroke induces massive, rapid activation of the peripheral immune system. J Cereb Blood Flow Metab. 2006;26:654–5.CrossRefPubMed
14.
go back to reference The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.CrossRef The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995;333:1581–7.CrossRef
15.•
go back to reference Boehme AK, Kumar AD, Dorsey AM, et al. Infections present on admission compared with hospital-acquired infections in acute ischemic stroke patients. J of Stroke and Cerebrov Dis. 2013;22(8):e582–9. This trial identified the specific detriment posed by infection in the early days after stroke and compared it to the lesser impact of pre-existing stroke.CrossRef Boehme AK, Kumar AD, Dorsey AM, et al. Infections present on admission compared with hospital-acquired infections in acute ischemic stroke patients. J of Stroke and Cerebrov Dis. 2013;22(8):e582–9. This trial identified the specific detriment posed by infection in the early days after stroke and compared it to the lesser impact of pre-existing stroke.CrossRef
16.••
go back to reference Shah SV, Corado C, Bergman D, et al. Impact of poststroke medical complications on 30-day readmission rate. J of Stroke and Cerebrov Dis. 2015;24(9):1969–77. This study highlights the incidence and impact of hospital complications upon readmission rate after stroke. These findings may prove pivotal in clinical strategies to lower readmission rate and optimize long-term recovery.CrossRef Shah SV, Corado C, Bergman D, et al. Impact of poststroke medical complications on 30-day readmission rate. J of Stroke and Cerebrov Dis. 2015;24(9):1969–77. This study highlights the incidence and impact of hospital complications upon readmission rate after stroke. These findings may prove pivotal in clinical strategies to lower readmission rate and optimize long-term recovery.CrossRef
17.•
go back to reference Ji R, Wang D, Shen H, et al. Interrelationship among common medical complications after acute stroke. Stroke. 2013;44:3436–44. This study showed that not only is infection prevalent after ischemic stroke but also the presence of infection increases the risk for other post-stroke medical comorbidities.CrossRefPubMed Ji R, Wang D, Shen H, et al. Interrelationship among common medical complications after acute stroke. Stroke. 2013;44:3436–44. This study showed that not only is infection prevalent after ischemic stroke but also the presence of infection increases the risk for other post-stroke medical comorbidities.CrossRefPubMed
18.
go back to reference Berger B, Gumbinger C, Steiner T, et al. Epidemiologic features, risk factors, and outcome of sepsis in stroke patients treated on a neurologic intensive care unit. J of Crit Care. 2014;29:241–8.CrossRef Berger B, Gumbinger C, Steiner T, et al. Epidemiologic features, risk factors, and outcome of sepsis in stroke patients treated on a neurologic intensive care unit. J of Crit Care. 2014;29:241–8.CrossRef
19.
go back to reference Westendorp WF, Vermeij J, Zock E, et al. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomized open-label masked endpoint clinical trial. Lancet. 2015;385:1519–26.CrossRef Westendorp WF, Vermeij J, Zock E, et al. The Preventive Antibiotics in Stroke Study (PASS): a pragmatic randomized open-label masked endpoint clinical trial. Lancet. 2015;385:1519–26.CrossRef
20.
go back to reference Laban KG, Rinkel GJ, Vergouwen MDI. Nosocomial infections after aneurysmal subarachnoid hemorrhage: time course and causative pathogens. Int J Stroke. 2015;10:763–6.CrossRefPubMed Laban KG, Rinkel GJ, Vergouwen MDI. Nosocomial infections after aneurysmal subarachnoid hemorrhage: time course and causative pathogens. Int J Stroke. 2015;10:763–6.CrossRefPubMed
22.
go back to reference Prass K, Meisel C, Hoflich C, et al. Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation. J Exp Med. 2003;19:725–36.CrossRef Prass K, Meisel C, Hoflich C, et al. Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like immunostimulation. J Exp Med. 2003;19:725–36.CrossRef
23.
go back to reference Hannawi Y, Hannaw B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35:430–3.CrossRefPubMed Hannawi Y, Hannaw B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35:430–3.CrossRefPubMed
24.
go back to reference Dziedzic T, Slowik A, Pera J, et al. B-blockers reduce the risk of early death in ischemic stroke. J Neurol Sci. 2007;252:53–6.CrossRefPubMed Dziedzic T, Slowik A, Pera J, et al. B-blockers reduce the risk of early death in ischemic stroke. J Neurol Sci. 2007;252:53–6.CrossRefPubMed
25.
go back to reference Sykora M, Siarnik P, Diedler J, et al. B-Blockers, pneumonia, and outcome after ischemic stroke. Stroke. 2015;46:1269–74.CrossRefPubMed Sykora M, Siarnik P, Diedler J, et al. B-Blockers, pneumonia, and outcome after ischemic stroke. Stroke. 2015;46:1269–74.CrossRefPubMed
26.
go back to reference Wong CH, Jenne CN, Lee WY, et al. Functional innervation of hepatic iNKT cells is immunosuppressive following stroke. Science. 2011;334:101–5.CrossRefPubMed Wong CH, Jenne CN, Lee WY, et al. Functional innervation of hepatic iNKT cells is immunosuppressive following stroke. Science. 2011;334:101–5.CrossRefPubMed
27.••
go back to reference Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947. This comprehensive guideline includes instruction on minimizing and treating infection occurring after stroke. While many new strategies for limiting post-stroke infection are being explored, this manuscript represents current best practice.CrossRefPubMed Jauch EC, Saver JL, Adams HP, et al. Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2013;44:870–947. This comprehensive guideline includes instruction on minimizing and treating infection occurring after stroke. While many new strategies for limiting post-stroke infection are being explored, this manuscript represents current best practice.CrossRefPubMed
28.•
go back to reference Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcomes. Stroke. 2000;31:410–4. Fever has traditionally been accepted as a marker of injury severity. This study demonstrates that fever is independently associated with poor outcome after stroke.CrossRefPubMed Hajat C, Hajat S, Sharma P. Effects of poststroke pyrexia on stroke outcomes. Stroke. 2000;31:410–4. Fever has traditionally been accepted as a marker of injury severity. This study demonstrates that fever is independently associated with poor outcome after stroke.CrossRefPubMed
29.
go back to reference Mrozek S, Vardon F, and Geeraerts T. Brain temperature: physiology and pathophysiology after brain injury. Anesthesiol Res Pract. 2012. doi:10.1155/2012/989487. Mrozek S, Vardon F, and Geeraerts T. Brain temperature: physiology and pathophysiology after brain injury. Anesthesiol Res Pract. 2012. doi:10.​1155/​2012/​989487.
30.
go back to reference Schreskinger M, Marion DW. Contemporary management of traumatic intracranial hypertension: is there a role for therapeutic hypothermia? Neurocrit Care. 2009;11:427–36.CrossRef Schreskinger M, Marion DW. Contemporary management of traumatic intracranial hypertension: is there a role for therapeutic hypothermia? Neurocrit Care. 2009;11:427–36.CrossRef
31.
go back to reference Lanier WL. Cerebral metabolic rate and hypothermia: their relationship with ischemic injury. J Neurosurg Anesthesiol. 1995;7(3):216–21.CrossRefPubMed Lanier WL. Cerebral metabolic rate and hypothermia: their relationship with ischemic injury. J Neurosurg Anesthesiol. 1995;7(3):216–21.CrossRefPubMed
32.
go back to reference Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet. 2008;371:1955–69.CrossRefPubMed Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet. 2008;371:1955–69.CrossRefPubMed
33.
go back to reference Badjatia N. Fever control in the NeuroICU: why, who and when? Crit Care Med. 2009;15:79–82. Badjatia N. Fever control in the NeuroICU: why, who and when? Crit Care Med. 2009;15:79–82.
34.
Metadata
Title
Impact of Infection on Stroke Morbidity and Outcomes
Authors
Chad M. Miller
Réza Behrouz
Publication date
01-09-2016
Publisher
Springer US
Published in
Current Neurology and Neuroscience Reports / Issue 9/2016
Print ISSN: 1528-4042
Electronic ISSN: 1534-6293
DOI
https://doi.org/10.1007/s11910-016-0679-9

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