Rinawati Weny, Aryati Aryati, Machin Abdulloh, Kiechl Stefan, Broessner Gregor
Doctoral Program in Medical Science, Faculty of Medicine, Universitas Airlangga, Surabaya 60132, Indonesia.
Laboratory and Blood Bank Unit, National Brain Center Hospital Mahar Mardjono, Jakarta 13630, Indonesia.
Epidemiologia (Basel). 2025 Aug 11;6(3):46. doi: 10.3390/epidemiologia6030046.
BACKGROUND/OBJECTIVES: Infections after stroke are a serious medical problem and have a significant impact on the outcome of stroke, but data regarding the Asian population are limited. This study aims to determine the bacterial and fungal profile of pathogenic organisms of infections after acute ischemic stroke (AIS).
This is a retrospective study using the medical records of patients at least 18 years old who were hospitalized with AIS in a tertiary stroke hospital from 1 January 2018 to 31 December 2022. Demographic, patient-related, and other examination data were extracted from hospital medical records. Infections after AIS were defined as any infection that developed during the acute phase of ischemic stroke and was confirmed by microbiologic culture as the gold standard. Factors associated with infection were analyzed using multiple logistic regression.
Among 599 AIS patients with infection who underwent microbiologic culture, the prevalence of infection with an isolated pathogen was 21.4%, and most organisms were from sputum. Positive microbiologic culture revealed that bacteria such as , , , and were the most common causes of infection, while fungi were rare. During the COVID-19 period, bacteria developed resistance to antimicrobials, including β-lactamase antibiotics for Gram-negative bacteria and methicillin for Gram-positive bacteria. Care in the intensive ward, including the stroke unit, reduced the risk of a positive microbiological culture in the COVID-19 and non-COVID-19 period. Urinary catheters promoted infections in the non-COVID-19 period, whereas steroids, total parenteral nutrition, and tracheostomy were negatively associated with infections after AIS in the COVID-19 period.
The prevalence and factors associated with infection after stroke changed during the COVID-19 period. The risk of infection after stroke requires preventive measures such as early dysphagia screening.
背景/目的：卒中后感染是一个严重的医学问题，对卒中结局有重大影响，但关于亚洲人群的数据有限。本研究旨在确定急性缺血性卒中（AIS）后感染的致病微生物的细菌和真菌谱。
这是一项回顾性研究，使用了2018年1月1日至2022年12月31日在一家三级卒中医院因AIS住院的至少18岁患者的病历。从医院病历中提取人口统计学、患者相关及其他检查数据。AIS后感染定义为在缺血性卒中急性期发生且经微生物培养确诊（以微生物培养为金标准）的任何感染。使用多因素逻辑回归分析与感染相关的因素。
在599例接受微生物培养的AIS感染患者中，分离出病原体的感染患病率为21.4%，大多数微生物来自痰液。微生物培养阳性显示， 、 、 和 等细菌是最常见的感染原因，而真菌很少见。在新冠疫情期间，细菌对包括革兰氏阴性菌的β-内酰胺酶抗生素和革兰氏阳性菌的甲氧西林在内的抗菌药物产生了耐药性。在包括卒中单元在内的重症监护病房接受治疗，在新冠疫情期间和非新冠疫情期间均降低了微生物培养阳性的风险。导尿管在非新冠疫情期间促进感染，而在新冠疫情期间，类固醇、全胃肠外营养和气管切开术与AIS后感染呈负相关。
在新冠疫情期间，卒中后感染的患病率及相关因素发生了变化。卒中后感染风险需要采取如早期吞咽困难筛查等预防措施。
