Clinical Aspects And Prognostic Factors Of Chronic-Onset Of Post-Stroke Pneumonia

ObjectiveSenile pneumonia is different from young adults in many aspects, such as clinical features, pathogens, outcome and so on. Post-stroke people often have immunologic function defects and a large part of them have dysphagia, their general conditions are worse than general senile pneumonia,and they often have a worse outcome. The aims of the study are to investigate and analyse the clinical features, pathogens transitions and the relationships between frist chosen antibiotics and outcomes of senile chronic-onset post-stroke penumonia, further to provide evidences for their treatments.MethodsIt was a retrospective analysis with case-control study design. All the medical records of consecutive patients aged>65 yrs with diagnosis of pneumonia from January 2009 to December 2010 in the Second Hospital of Shan Dong University were searched. According to the inclusion and exclusion criteria of senile chronic-onset post-stroke penumonia and general senile pneumonia, we screened out 60 episodes of senile chronic-onset post-stroke pneumonia and 60 episodes of general senile pneumonia. By a special enrollment we recorded all the enrolled episodes, such as gender, age, dysphagia, body temperature, routine analysis of blood, albumin, first sputum smear of bacteria and fungi, first sputum culture of bacteria and fungi, frist chosen antibiotics, drug resistance, mechanical ventilation(MV), nasogastric tube, antibiotics we had chosen, outcomes, as well as hospital stays. Used the Independent-Sample T Test and Chi-Square Test to analysis the differences between senile chronic-onset post-stroke pneumonia and senile pneumonia in clinical features and pathogens. Used the Independent-Sample T Test to analysis the effects of related elements to hospital stays, identified factors associated with hospital stays, and their correlation was determined by correlation analysis and regression analysis. Used the Chi-Square Test to analysis the effects of related elements to outcome, identified factors associated with hospital stays, and their correlation was determined by multivariate analysis with Logistic regression.ResultsCompared to senile pneomonia patients, senile chronic-onset post-stroke pneumonia patients had a higher probability of accompanied hypertension and diabetic mellitus(DM). The ratio of hyper-leukocyte was not different between the two groups, but the numeration of leukocyte was higher than control group. They had higher probability of hypoalbuminemia than senile pneumonia patients. The senile chronic-onset post-stroke pneumonia group had lower arterial partial pressure of oxygen than control group, and they tended to have bilateral infiltrates found by chest imaging. Compared to senile pneomonia patients, they had higher positive rates in sputum bacterial smear, but the positive rates of sputum fungi smear had no difference. The first sputum cultures were more likely to find gram-negtive bacteria(GNB), particularly Escherichia coli(E. coli), following by pseudomonas aeruginosa(PA). The treatment efficiency was higher in patients whom first chosen combination antibiotics. If we wanted to have a better outcome, we needed to choose antibiotics which had broad spectrum, and tried to cover these most commom pathogens. The senile chronic-onset post-stroke pneumonia patients had longer hospital stays and worse outcomes than control group.We found 37 strains of gram negtive bacteria among senile chronic-onset post-stroke pneumonia patients, the common feature was multiple drug resistance. The most common ESBLs-produced bacteria was E. coli, carbapenem were the most sensitive to them. We found 6 strains MRSA, which were highly resistant to all P-lactams. We found 9 strains fungi, which were sensitive to anphotericin B, 5-flucytosine and voriconazole, in addition they were highly resistent to itraconazole.The hospital stays of senile chronic-onset post-stroke pneumonia patients was associated with hypoalbuminemia, chest imaging, MV and nasogastric tube. The related coefficient between hospital stays and hypoalbuminemia was-0.519, P values was less than 0.001, they were negtive correlated. The related coefficient between hospital stays and chest imaging was 0.339, P values was less than 0.001, they were positive correlated. The related coefficient between hospital stays and MV was 0.547, P values was less than 0.001, they were positive correlated. The related coefficient between hospital stays and nasogastric tube was 0.683, P values was less than 0.001, they were positive correlated. Regression analysis showed nasl feeding and hospitalization time were related.The outcomes of senile chronic-onset post-stroke pneumonia patients was associated with hypoalbuminemia, dysphagia, MV and nasogastric tube. There were one factors associated with prognosis on multivariate analysis with Logistic regression, OR values was 2.551.ConclusionsThe general conditions of senile chronic-onset post-stroke pneumonia were much worse, they often had accompanied by other diseases, had higher numeration of leukocyte, lower albumin level, and lower arterial partial pressure of oxygen. They tended to have bilateral infiltrations, and they needed longer hospital stays and had poorer outcome.They were likely to find gram-negtive bacteria (GNB) at the first sputum cultures, particularly E. coli, following by PA. We needed to choose antibiotics which had broad spectrum, and tried to cover all the possible pathogens to achieve a better outcome.The drug sensitivity of infected bacteria were tend to be multiple resistent, and the treatment efficiency was higher in patients whom first chosen bigeminal antibiotics.Nasogastric tube was related to longer hospital stays, while MV was an independent risk factor to outcome, we must pay more attention to them.