Skip to main content

Advertisement

Log in

Impact of Infection on Stroke Morbidity and Outcomes

  • Infection (J Halperin, Section Editor)
  • Published:
Current Neurology and Neuroscience Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Shim R, Wong CH. Ischemia, immunosuppression and infection, tackling the predicaments of post-stroke complications. Int J Mol Sci. 2016;17:64.

    Article  PubMed Central  Google Scholar 

  2. 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.

    Article  PubMed  Google Scholar 

  3. 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.

    Article  Google Scholar 

  4. 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.

    Article  Google Scholar 

  5. Teramoto S. Novel preventive and therapeutic strategy for post-stroke pneumonia. Expert Rev Neurother. 2009;9:1187–200.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. Harms H, Prass K, Meisel C, et al. Preventive antibacterial therapy in acute ischemic stroke: a randomized controlled trial. PLoS One. 2008;3:e2158.

    Article  PubMed  PubMed Central  Google Scholar 

  8. 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.

    Article  PubMed  Google Scholar 

  9. Dziewas R, Ritter M, Schilling M, et al. Pneumonia in acute stroke patients fed by nasogastric tube. J Neurol Neurosurg Psychiatry. 2004;75:852–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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.

    Article  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Becker KJ, Dankwa D, Lee R, et al. Stroke, IL-1Ra, ILIRN, infection, and outcome. Neurocrit Care. 2014;21:140–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. 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.

    Article  Google Scholar 

  15. 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.

    Article  Google Scholar 

  16. 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.

    Article  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. 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.

    Article  Google Scholar 

  19. 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.

    Article  CAS  Google Scholar 

  20. Laban KG, Rinkel GJ, Vergouwen MDI. Nosocomial infections after aneurysmal subarachnoid hemorrhage: time course and causative pathogens. Int J Stroke. 2015;10:763–6.

    Article  PubMed  Google Scholar 

  21. Zierath D, Kunze A, Fecteau L, et al. Effect of antibiotic class on stroke outcome. Stroke. 2015;46:2287–92.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. 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.

    Article  Google Scholar 

  23. Hannawi Y, Hannaw B, Rao CP, et al. Stroke-associated pneumonia: major advances and obstacles. Cerebrovasc Dis. 2013;35:430–3.

    Article  CAS  PubMed  Google Scholar 

  24. 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.

    Article  CAS  PubMed  Google Scholar 

  25. Sykora M, Siarnik P, Diedler J, et al. B-Blockers, pneumonia, and outcome after ischemic stroke. Stroke. 2015;46:1269–74.

    Article  CAS  PubMed  Google Scholar 

  26. Wong CH, Jenne CN, Lee WY, et al. Functional innervation of hepatic iNKT cells is immunosuppressive following stroke. Science. 2011;334:101–5.

    Article  CAS  PubMed  Google Scholar 

  27. 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.

    Article  PubMed  Google Scholar 

  28. 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.

    Article  CAS  PubMed  Google Scholar 

  29. 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. Schreskinger M, Marion DW. Contemporary management of traumatic intracranial hypertension: is there a role for therapeutic hypothermia? Neurocrit Care. 2009;11:427–36.

    Article  Google Scholar 

  31. Lanier WL. Cerebral metabolic rate and hypothermia: their relationship with ischemic injury. J Neurosurg Anesthesiol. 1995;7(3):216–21.

    Article  CAS  PubMed  Google Scholar 

  32. Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet. 2008;371:1955–69.

    Article  PubMed  Google Scholar 

  33. Badjatia N. Fever control in the NeuroICU: why, who and when? Crit Care Med. 2009;15:79–82.

    Google Scholar 

  34. Hemmen T, Raman R, Guluma KZ, et al. Intravenous thrombolysis plus hypothermia for acute treatment of ischemic stroke. Stroke. 2010;41:2265–70.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Chad M. Miller.

Ethics declarations

Conflict of Interest

Chad M. Miller and Réza Behrouz declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Infection

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Miller, C.M., Behrouz, R. Impact of Infection on Stroke Morbidity and Outcomes. Curr Neurol Neurosci Rep 16, 83 (2016). https://doi.org/10.1007/s11910-016-0679-9

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11910-016-0679-9

Keywords

Navigation