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Open Access Research article

Post-stroke infection: A systematic review and meta-analysis

Willeke F Westendorp1, Paul J Nederkoorn1, Jan-Dirk Vermeij1, Marcel G Dijkgraaf2 and Diederik van de Beek13*

Author Affiliations

1 Department of Neurology, Academic Medical Center, Amsterdam, the Netherlands

2 Clinical Research Unit, Academic Medical Center, Amsterdam, the Netherlands

3 Center of Infection and Immunity (CINIMA), Academic Medical Center, Amsterdam, the Netherlands

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BMC Neurology 2011, 11:110  doi:10.1186/1471-2377-11-110

Published: 20 September 2011

Abstract

Background

stroke is the main cause of disability in high-income countries, and ranks second as a cause of death worldwide. Patients with acute stroke are at risk for infections, but reported post-stroke infection rates vary considerably. We performed a systematic review and meta-analysis to estimate the pooled post-stroke infection rate and its effect on outcome.

Methods

MEDLINE and EMBASE were searched for studies on post-stroke infection. Cohort studies and randomized clinical trials were included when post-stroke infection rate was reported. Rates of infection were pooled after assessment of heterogeneity. Associations between population- and study characteristics and infection rates were quantified. Finally, we reviewed the association between infection and outcome.

Results

87 studies were included involving 137817 patients. 8 studies were restricted to patients admitted on the intensive care unit (ICU). There was significant heterogeneity between studies (P < 0.001, I2 = 97%). The overall pooled infection rate was 30% (24-36%); rates of pneumonia and urinary tract infection were 10% (95% confidence interval [CI] 9-10%) and 10% (95%CI 9-12%). For ICU studies, these rates were substantially higher with 45% (95% CI 38-52%), 28% (95%CI 18-38%) and 20% (95%CI 0-40%). Rates of pneumonia were higher in studies that specifically evaluated infections and in consecutive studies. Studies including older patients or more females reported higher rates of urinary tract infection. Pneumonia was significantly associated with death (odds ratio 3.62 (95%CI 2.80-4.68).

Conclusions

Infection complicated acute stroke in 30% of patients. Rates of pneumonia and urinary tract infection after stroke were 10%. Pneumonia was associated with death. Our study stresses the need to prevent infections in patients with stroke.