External Validation Of Stroke-associated Pneumonia Predicting Scores And An Investigation Of Its Local Bacterial Epidemiology And Antibiotics Resistance

Objectives:stroke associated pneumonia(SAP)predicting scores are meaningful for early identification of high-risk SAP patients.But previous scores have not validate externally in thrombolysis patients and non-thrombolysis ischemic stroke patients.This study aims at the evaluation of SAP predicitng scores in thrombolysis and non-thrombolysis patients,including the A2DS2(The Age,Atrial fibrillation,Dysphagia,male Sex,stroke Severity,National Institutes of Health Stroke Scale,2012)score,the PANTHERIS(the Preventive ANtibacterial THERapy in acute Ischemic Stroke,2013)score,the AIS-APS(the Acute Ischemic Stroke-Associated Pneumonia Score,2013)and IS AN(The prestroke Independence,Sex,Age,National Institutes of Health Stroke Scale,2015)and provides evidence for further scores establishment.Methods:The CerebroVascular Database Project(CVDP)consecutively collect data of patients admitted in Zhongda Hospital and Wuxi Xishan Hospital with the diagnosis of acute cerebrovascular disease from 2016/02-2018/01.Through 1:1 age matching,a total of 138 thrombolysis patients and 138 non-thrombolysis ischemic stroke patients participated in this study.Receiver operating characteristic curves(ROC)comparisons are performed to examine the discrimination of the 4 predicting scores and Hosmer-Lemeshow test are used to evaluate the goodness of fit.As well,the diagnostic indexes such as sensitivity,specificity are analyzed.Results:1)The incidence of SAP in the total of 276 patients is 24.8%.2)There are no statistics significance between thrombolysis group and non-thrombolysis group in gender,present smoking,chronic obstructive pulmonary disease(COPD)history,atrial fibrillation(AF)history,admission blood pressure(BP)history and glucose level.But there are significant differences in NIHSS(National Institute of Health Stroke Scale)scores(non-thrombolysis group 3.8014.98 vs.Thrombolysis group 8.96±6.50,P<0.001),GCS(Glascow coma scale)scores(non-thrombolysis group 14.09±1.76 vs.Thrombolysis group 12.46±2.41,P<0.001),OCSP(Oxfordshire Community Stroke Project)classification(P<0.001),dyphagia(P<0.001)and white blood cell(WBC)counting(non-thrombolysis group 7.44±2.29 vs.Thrombolysis group 8.14±2.8,P=0.039).3)The area under curve(AUC)of ROC for A2DS2,PANTHERIS,AIS-APS and ISAN scores in total population are 0.80(0.74-0.84),0.75(0.69-0.80),0.80(0.76-0.85)and 0.76(0.71-0.81).The goodness of fit of them are0.22,0.22,0.27 and 0.17 separately.4)The 4 scores show different diagnostic indexes in thrombolysis and non-thrombolysis group.5)The AUC comparisons of 4 scores between thrombolysis and non-thrombolysis group are of no statistic significanceDiscussion:Patients in thrombolysis group show more severe stroke symptoms and signs than the non-thrombolysis group in CVDP database.It indicates the urgency and necessity of the public promotion for thrombolysis therapy.The AIS-APS establishment based on Chinese stroke registry population which showed more similarity with our population than other scores.It may explain the reason why AIS-APS owns the highest AUC and goodness of fit in our population.The 4 scores all can be applied in ischemic stroke patients with no need to discriminate acceptance of thrombolysis therapy or not.However,considering the characteristic diagnostic values,options can be madeObjectives:This study is aimed to get information of local bacterial epidemiology and antibiotics-resistance situation for evidence on initial experiential antibiotics selection through investigating the sputum culture results and the use of initial experiential antibiotics for stroke-associated pneumonia(SAP)patients admitted in the neurological department,Zhongda Hospital.Methods:Collecting the positive sputum culture and antibiotic-sensitivity test results from 51 SAP patients admitted in the neurological department,Zhongda Hospital from 2013/06/28-2018/01/01.Only the sputum culture collected within 7 days after stroke onset are included in the study.We use WHONET5.6 software to analyze the bacterial epidemiology and antibiotic-resistance condition.Meanwhile,we also record the initial antibiotic and calculate the efficiency.Results:The bacteria account for 69.23%and the fungi account for 30.77%in the total of 65 positive sputum culture.Acinetobacter baumannii(11,24.4%),klebsiella pneumoniae(11,24.4%)and pseudomonas aeruginosa(9,20.00%)takes the first three rank in order.The drug resistance rate for ? lactamase of Acinetobacter baumannii and pseudomonas aeruginosa are relatively high.The efficiency rate of initial antibiotic is 31.37%and the most common initial antibiotic is the kind of broad-spectrum penicilin+? lactamase inhibitor,such as piperacillin-tazobactam and meroxicillin sulbactam sodium.Discussions:It shows that the local common-use initial experiential antibiotic resistance rate is high for common bacteria cultivated from the sputum of SAP patients.The local initial antibiotics needs to be adjusted.