Risk factors and pathogenic microorganism characteristics for pneumonia in convalescent patients with stroke: A retrospective study of 380 patients from a rehabilitation hospital

Predictive modelling of hospital-acquired infection in acute ischemic stroke using machine learning

Hospital-acquired infections (HAIs) are serious complication for patients with acute ischemic stroke (AIS), often resulting in poor functional outcomes. However, no existing model can specifically predict HAI in AIS patients. Therefore, we employed the Gradient Boosting matching learning algorithm to establish predictive models for HAI occurrence in AIS patients and poor 30-day functional outcomes (modified Rankin Scale > 2) in AIS patients with HAI by analyzing electronic health records from 6560 AIS patients. Model performance was evaluated through internal cross-validation and external validation using an independent cohort of 3521 AIS patients. The established models demonstrated robust predictive performance for HAI in AIS patients, achieving area under the receiver operating characteristic curves (AUROCs) of 0.857 ± 0.008 during internal validation and 0.825 ± 0.002 during external validation. For AIS patients with HAI, the second model effectively predict poor 30-day functional outcomes, with AUROCs of 0.905 ± 0.009 during internal validation and 0.907 ± 0.002 during external validation. In conclusion, machine learning models effectively identify the HAI occurrence and predict poor 30-day functional outcomes in AIS patients with HAI. Future prospective studies are crucial for validating and refining these models for clinical application, as well as for developing an accessible flowchart or scoring system to enhance clinical practices.

Bacteriological Profile of Patients With Stroke-Associated Pneumonia and Antimicrobial Susceptibility of Pathogens: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Stroke-associated pneumonia (SAP) is the aftermath of aspiration of oropharyngeal secretions or stomach content. Mechanical ventilation and lowered immunity and consciousness facilitate the etiopathogenesis of SAP. Antibiotic prophylaxis and repeated culture and sensitivity testing dampen the drug susceptibility patterns of the pathogens. We accomplished this study to determine the bacteriological profile of patients with SAP and the antimicrobial susceptibility patterns of the pathogenic bacteria.

METHODS

This cross-sectional study was executed from August 2022 to May 2024 at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India. We included adult patients who endured treatment in the neurosurgery intensive care unit (ICU) throughout the study period due to a stroke and developed pneumonia within 48 hours of admission. The endotracheal tube (ET) aspirate and bronchoalveolar lavage (BAL) fluid specimens collected from the eligible participants were analyzed. Enriched and selective media such as 5% sheep blood agar, chocolate agar, and MacConkey agar were used to culture pathogenic bacteria. The VITEK 2 system was used to identify isolates and assess antimicrobial susceptibility testing (AST). The pathogenic bacteria and their antimicrobial susceptibility patterns were gauged. We leveraged R software (version 4.4.1) for data analysis.

RESULTS

Two hundred forty bacterial isolates were found in the 181 eligible patients. Forty-eight (26.52%) participants were females. The median age of the study population was 64.50 (58.74-70.24) years. Fifty-nine (32.60%) participants had two different isolates in their culture reports. We found the following non-fermenters: Acinetobacter baumannii (55, 22.92%), Pseudomonas aeruginosa (31, 12.92%), Burkholderia cepacia (6, 2.50%), and Elizabethkingia meningoseptica (4, 1.67%). Klebsiella pneumoniae (88, 36.67%) and Escherichia coli (15, 6.25%) were the most commonly noticed Enterobacterales. Other Enterobacterales were Proteus mirabilis (9, 3.75%), Serratia marcescens (8, 3.33%), Klebsiella oxytoca (3, 1.25%), Enterobacter aerogenes (1, 0.42%), Providentia stuartii (1, 0.42%), and Enterobacter cloacae complex (5, 2.08%). Staphylococcus aureus (14, 5.83%) was the only gram-positive cocci in our study population. The sensitivity of A. baumannii was maximum for minocycline. P. aeruginosa was highly sensitive to imipenem and completely resistant to tigecycline. Minocycline was the only effective drug against E. meningoseptica. Similarly, the Enterobacterales had the greatest sensitivity for tigecycline. All 14 specimens of S. aureus were sensitive to both vancomycin and linezolid. They were responsive to tigecycline as well.

CONCLUSION

The most common pathogenic bacteria in our study were K. pneumoniae, A. baumannii, P. aeruginosa, E. coli, and S. aureus. Enterobacterales were highly sensitive to tigecycline. A. baumannii and E. meningoseptica had maximum sensitivity for minocycline. All isolates of S. aureus were sensitive to both vancomycin and linezolid. We warrant further research with a larger sample size to investigate the bacteriological profile among other critically ill patients and their AST findings.

Development and validation of a prediction model for hypoproteinemia after traumatic spinal cord injury: A multicenter retrospective clinical study

A multicenter retrospective analysis of conventionally collected data. To identify the potential causes of hypoproteinemia after traumatic spinal cord injury (TSCI) and provide a diagnostic model for predicting an individual likelihood of developing hypoproteinemia. Hypoproteinemia is a complication of spinal cord injury (SCI), an independent risk factor for respiratory failure in elderly patients with SCI, and a predictor of outcomes in patients with cervical SCI. Few nomogram-based studies have used clinical indicators to predict the likelihood of hypoproteinemia following TSCI. This multicenter retrospective clinical analysis included patients with TSCI admitted to the First Affiliated Hospital of Guangxi Medical University, Wuzhou GongRen Hospital, and Dahua Yao Autonomous County People Hospital between 2016 and 2020. The data of patients from the First Affiliated Hospital of Guangxi Medical University were used as the training set, and those from the other 2 hospitals were used as the validation set. All patient histories, diagnostic procedures, and imaging findings were recorded. To predict whether patients with TSCI may develop hypoproteinemia, a least absolute shrinkage and selection operator regression analysis was conducted to create a nomogram. The model was validated by analyzing the consequences using decision curve analysis, calibration curves, the C-index, and receiver operating characteristic curves. After excluding patients with missing data, 534 patients were included in this study. Male/female sex, age ≥ 60 years, cervical SCI, pneumonia, pleural effusion, urinary tract infection (UTI), hyponatremia, fever, hypotension, and tracheostomy were identified as independent risk factors of hypoalbuminemia. A simple and easy-to-replicate clinical prediction nomogram was constructed using these factors. The area under the curve was 0.728 in the training set and 0.881 in the validation set. The predictive power of the nomogram was satisfactory. Hypoalbuminemia after TSCI may be predicted using the risk factors of male/female sex, age ≥ 60 years, cervical SCI, pneumonia, pleural effusion, UTI, hyponatremia, fever, hypotension, and tracheostomy.

Clinical prediction score for prolonged length of hospital stay in aneurysmal subarachnoid hemorrhage

BACKGROUND

Length of stay (LOS) is an important indicator of the optimization of health services and hospital financing efficiency in aneurysmal subarachnoid hemorrhage (aSAH) patients. The purpose of this study was to develop a scoring model to predict the LOS of patients with aSAH.

METHOD

A clinical scoring was developed based on retrospectively collected data from the cerebral aneurysm registry of the National Brain Center Hospital, Jakarta, from January 2019 to June 2022. Multivariate logistic regression was used to determine the odds ratio for risk-adjusted prolonged LOS. LOS predictors were obtained based on the regression coefficients and converted into a point score model.

RESULTS

Of the 209 aSAH patients observed, 117 patients had prolonged LOS (> 14 days of hospital stay). A clinical score was developed with a range of 0-7 points. Four variables were chosen as predictors of prolonged LOS: the presence of high-grade aSAH (1 point), aneurysm treatment (endovascular coiling: 1 point; surgical clipping: 2 points), cardiovascular comorbidities (1 point), and hospital-acquired pneumonia (3 points). The score showed good discrimination with an area under the receiving operating characteristics curve (AUC) of 0.8183 (SE 0.0278) and a p-value for the Hosmer-Lemeshow (HL) goodness-of-fit of 0.9322.

CONCLUSION

This simple clinical score reliably predicted prolonged LOS in aneurysmal subarachnoid hemorrhage cases and may aid clinicians in improving patient outcomes and decreasing healthcare costs.

Nanomaterials as carriers to improve the photodynamic antibacterial therapy

The main treatment for bacterial infections is antibiotic therapy, but the emergence of bacterial resistance has severely limited the efficacy of antibiotics. Therefore, another effective means of treating bacterial infections is needed to alleviate the therapeutic pressure caused by antibiotic resistance. Photodynamic antibacterial therapy (PDAT) has gradually entered people's field of vision as an infection treatment method that does not depend on antibiotics. PDAT induces photosensitizers (PS) to produce reactive oxygen species (ROS) under light irradiation, and kills bacteria by destroying biological macromolecules at bacterial infection sites. In recent years, researchers have found that some nanomaterials delivering PS can improve PDAT through targeted delivery or synergistic therapeutic effect. Therefore, in this article, we will review the recent applications of several nanomaterials in PDAT, including metal nanoclusters, metal-organic frameworks, and other organic/inorganic nanoparticles, and discuss the advantages and disadvantage of these nanomaterials as carriers for delivery PS to further advance the development of PDAT.

Bibliometric analysis of global research trends on post-stroke pneumonia: Current development status and research Frontiers

Background

As one of the most common complications of stroke, post-stroke pneumonia significantly increases the incidence of adverse outcomes, mortality, and healthcare costs for patients with stroke. As the field of post-stroke pneumonia has gained interest in the recent years, there has been an increasing number of publications on post-stroke pneumonia research worldwide. Therefore, a more comprehensive understanding of the field is needed now. This paper is intended to analyze the research status and detect the research frontiers in this field.

Methods

VOS viewer, CiteSpace, and the online scientometric platform (https://bibliometric.com/) were the main visualization tools used in this paper. They were used to perform citation analysis of countries/institutions, co-citation analysis of authors/journals/references, co-authorship analysis of authors, co-occurrence analysis of keywords, and citation bursts analysis of references.

Results

The number of publications in this field has increased rapidly since 2010 and is expected to continue to increase in the next few years. The countries contributing most to post-stroke pneumonia research were the USA, China, and Germany. The most productive institution was Harvard University, followed by Humboldt University of Berlin, Charité Universitätsmedizin Berlin, and Free University of Berlin from Germany. Meanwhile, the German authors Meisel A, Meisel C, and Dirnagl U, who have contributed significantly to this field, were all associated with these three German institutions. The high-quality and high output journal was STROKE. In the coming years, the hot topic keywords “risk & risk-factors,” “outcome & impact,” “management & guidelines,” and “predictors” will gain more attention in this field. Finally, hot keywords were grouped into four clusters in this paper: cluster 1 (risk-factors studies of post-stroke pneumonia), cluster 2 (clinically relevant studies of post-stroke pneumonia), cluster 3 (mechanism studies of post-stroke pneumonia), and cluster 4 (care studies of post-stroke pneumonia).

Conclusion

This study shows the knowledge structure and evolution of the field of post-stroke pneumonia research and predicts research trends through visualization analysis. The future trend of post-stroke pneumonia research will gradually shift from clinical and mechanistic studies to treatment and prevention studies.

Clinical and Microbiological Analysis of Hospital-Acquired Pneumonia Among Patients With Ischemic Stroke: A Retrospective Outlook

Background Hospital-acquired pneumonia (HAP) is a leading cause of morbidity and mortality in patients with ischemic stroke. Our study aims to explore the clinical and microbiological aspects (culture and sensitivity) of stroke patients with a confirmed diagnosis of HAP. Methodology This retrospective cross-sectional study included a total of 232 patients with a confirmed diagnosis of HAP following ischemic stroke. HAP was diagnosed based on the timing of onset of symptoms and chest X-ray. Patients were evaluated for their demographic details and a myriad of clinical parameters including dysphagia, mechanical ventilation, mortality, spontaneous pneumothorax, and Glasgow coma scale (GCS) score. The frequencies of different microorganisms isolated from the tracheal secretions were reported. Thereafter, the percentages of resistant isolates against a plethora of antimicrobial agents were tabulated. Results Out of 232 patients, 110 were males and 122 were females with a mean age of 58.79 ± 8.62 years. Dysphagia and mechanical ventilation were present in 66.4% and 72%, respectively. The mortality rate was 30.6%. Klebsiella pneumoniae was the most frequently isolated organism (28.9%), followed by Escherichia coli (24.5%), and Pseudomonas aeruginosa (23.3%). The antimicrobial resistance patterns of most of the isolates against different antibiotics were alarmingly high. Conclusions Dysphagia and mechanical ventilation are frequently present in patients of ischemic stroke with associated HAP. The antimicrobial resistance patterns of the isolated organisms are a cause of major concern. This necessitates the need for proper sanitation and the careful use of antibiotics.