Post-stroke Infections – Diagnosis, Prediction, Prevention and Treatment


decisions. However, the resistance pattern of E. coli strains and other pathogens causing UTI may vary considerably between European regions and countries, so that no general recommendations are suitable throughout Europe.


The following antimicrobials can be considered (see Table 5): trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones (e.g. ciprofloxacin, levofloxacin,) and β-lactams (e.g. ampicillin/sulbactam, ceftriaxone). Treatment duration should not exceed seven days.


Conclusion and Perspectives


Even in dedicated stroke units with regular quality management protocols, post-stroke infections remain relevant complications that can be prevented and treated. Although their effect on long- term outcome remains an open issue, it is highly probable that post-stroke infections have a negative impact on mortality and neurological status. In the next few years, several predictive tools (e.g. clinical scores, blood-borne biomarkers) will be developed and validated. Thus, patients at risk will be identified early and reliably. Additionally, pre-emptive and biomarker-guided anti-infective treatment approaches will be tested to improve neurological outcome after stroke. n


1. 2. 3. 4.


Davenport RJ, Dennis MS, Wellwood I, Warlow CP, Stroke, 1996;27(3):415–20.


Langhorne P, Stott DJ, Robertson L, et al., Stroke, 2000;31(6):1223–9.


Langhorne P, Williams BO, Gilchrist W, Howie K, Lancet, 1993;342(8868):395–8.


Tong X, Kuklina EV, Gillespie C, George MG, Stroke, 2010;41(5):980–86.


5. Heuschmann PU, Kolominsky-Rabas PL, Misselwitz B, et al., Arch Intern Med, 2004;164(16):1761–8.


6. 7. 8. 9. 10. 11.


Meisel C, Schwab JM, Prass K, et al., Nat Rev Neurosci, 2005;6(10):775–86.


Emmerson AM, Enstone JE, Griffin M, et al., J Hosp Infect, 1996;32(3):175–90.


Andersen BM, Ringertz SH, Gullord TP, et al., J Hosp Infect, 2000;44(3):214–23.


Hilker R, Poetter C, Findeisen N, et al., Stroke, 2003;34(4):975–81.


Dirnagl U, Klehmet J, Braun JS, et al., Stroke, 2007;38(Suppl. 2):770–73.


Chamorro A, Urra X, Planas AM, Stroke, 2007;38(3):1097–1103.


12. Emsley HC, Hopkins SJ, Lancet Neurol, 2008;7(4):341–53. 13.


Rothan-Tondeur M, Meaume S, Girard L, et al., J Am Geriatr Soc, 2003; 51(7):997–1001.


14. Maki DG, Tambyah PA, Emerg Infect Dis, 2001;7(2):342–7. 15.


Gould C, Allen-Bridson K, Horan T, Clin Infect Dis, 2009;49(8):1288–9.


16.


Bartlett JG, Dowell SF, Mandell LA, et al., Clin Infect Dis, 2000;31:347–82.


17. Melbye H, Dale K, Acta Radiol, 1992;33(1):79–81. 18. Young M, Marrie TJ, Arch Intern Med, 1994;154(23):2729–32. 19.


20. 21. 22. 23. 24.


Nakajoh K, Nakagawa T, Sekizawa K, et al., J Intern Med, 2000;247(1):39–42.


Hilker R, Poetter C, Findeisen N, et al., Stroke, 2003;34(4):975–81.


Aslanyan S, Weir CJ, Diener HC, et al., Eur J Neurol, 2004;11:49–53.


Walter U, Knoblich R, Steinhagen V, et al., J Neurol, 2007;254(10):1323–9.


Hug A, Dalpke A, Wieczorek N, et al., Stroke,


Niederman MS, Mandell LA, Anzneto A, et al., Am J Respir Crit Care Med, 2001;163:1730–54.


2009;40(10):3226–32. 25. 26. 27. 28. 29. 30. 31.


32. 33.


34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44.


Kwon HM, Jeong SW, Lee SH, Yoon BW, Am J Infect Control, 2006;34(2):64–8.


Sellars C, Bowie L, Bagg J, et al., Stroke, 2007;38(8):2284–91.


Huxley EJ, Viroslav J, Gray WR, Pierce AK, Am J Med, 1978;64:564–68.


Gleeson K, Eggli DF, Maxwell SL, Chest, 1997;111:1266–72.


Dziedzic T, Slowik A, Szczudlik A, Crit Care, 2004;8(4):266–70.


Prass K, Meisel C, Hoflich C, et al., J Exp Med, 2003;198(5):725–36.


Offner H, Subramanian S, Parker SM, et al., J Immunol, 2006;176(11):6523–31.


Meisel C, Prass K, Braun J, et al., Stroke, 2004; 35(1):2–6.


Schulte-Herbruggen O, Klehmet J, Quarcoo D, et al., Neuroimmunomodulation, 2006;13(1):13–18.


Braun JS, Prass K, Dirnagl U, et al., Exp Neurol, 2007;206(2):183–91.


Prass K, Braun JS, Dirnagl U, et al., Stroke, 2006;37(10):2607–12.


Harms H, Prass K, Meisel C, et al., PLoS One, 2008;14;3(5):e2158.


Haeusler KG, Schmidt WU, Fohring F, et al., Cerebrovasc Dis, 2008;25(1–2):50–58.


Chamorro A, Amaro S, Vargas M, et al., J Neurol Neurosurg Psychiatry, 2006; 77(11):1279–81.


Chamorro A, Amaro S, Vargas M, et al., J Neurol Sci, 2007;252(1):29–35.


Czlonkowska A, Cyrta B, Korlak J, J Neurol Sci, 1979;43(3):455–64.


Vogelgesang A, Grunwald U, Langner S, et al., Stroke, 2008;39(1):237–41.


Klehmet J, Harms H, Richter M, et al., Neuroscience, 2009;158(3):1184–93.


Urra X, Cervera A, Obach V, et al., Stroke, 2009;40(4):1262–8.


Stott DJ, Falconer A, Miller H, et al., QJM, 2009;102(4):243–9.


45. Kong KH, Young S, Arch Phys Med Rehabil, 2000;81:1464–7. 46.


Ersoz M, Tunc H, Akyuz M, Ozel S, Cerebrovasc Dis, 2005;20:395–9.


47. Linden P, Siebens A, Arch Phys Med Rehabil, 1983;64:281–4. 68. 57. 58.


Hendrik Harms is a Clinical Scientist at the Centre for Stroke Research Berlin and an Attending Neurologist in the Department of Neurology at the Charité Medical University Berlin. His scientific and clinical focus is ischaemic stroke and its implication for immune functions, and the pathogenesis of autoimmune neuropathies.


Elke Halle is a Clinical Scientist and Attending Microbiologist at the Institute for Microbiology and Hygiene. A clinical microbiologist and an expert on antibiotical therapies, she has been involved in the conception of the German S3 guidelines for community-acquired pneumonia. Over the past 10 years she has collaborated with Drs Meisel and Harms in the conception and investigation of preventative anti-infective therapy as a treatment strategy in stroke.


Andreas Meisel is a Professor of Neurology at the NeuroCure Clinical Research Centre and the Centre for Stroke Research Berlin and an Attending Physician and Neurointensivist in the Department of Neurology at the Charité Medical University Berlin, where his work is mainly focused on stroke and myasthenia gravis. His group is active in the field of experimental and clinical stroke research, dissecting mechanisms and functional relevance of stroke-induced immunodepression and endogenous neuroprotection and brain repair.


48.


Splaingard M, Hutchins B, Sulton L, Chaudhuri G, Arch Phys Med Rehabil, 1988;69:637–40.


49. Perry L, Love C, Dysphagia, 2001;16:7–18. 50.


51. 52.


53. 54.


55. 56.


Hinchey JA, Shephard T, Furie K, et al., Stroke, 2005;36(9):1972–6.


Wiggam MI, Webster A, Dennis MS, Age Ageing, 2001;30(Suppl. 2):72.


Dennis MS, Lewis SC, Warlow C, Lancet, 2005;365(9461):764–7.


Meisel C, Prass K, Braun J, et al., Stroke, 2004;35(1):2–6.


Chamorro A, Horcajada JP, Obach V, et al., Stroke, 2005;36(7):1495–1500.


Schwarz S, Al-Shajlawi F, Sick C, et al., Stroke, 2008;39(4):1220–27.


van de Beek D, Wijdicks EF, Vermeij FH, et al., Arch Neurol, 2009;66(9):1076–81.


Gokula RM, Smith MA, Hickner J, Am J Infect Control, 2007;35:589–93.


Topal J, Conklin S, Camp K, et al., Am J Med Qual, 2005;20:121–6.


59. Schumm K, Lam TB, Cochrane Database Syst Rev, 2008;2:CD004013.


60. 61. 62.


Saint S, Kaufman SR, Rogers MA, et al., J Am Geriatr Soc, 2006;54:1055–61.


Hooton TM, Bradley SF, Cardenas DD, et al., Clin Infect Dis, 2010;50(5):625–63.


Adams HP Jr, del Zoppo G, Alberts MJ, et al., Stroke, 2007;38(5):1655–1711.


63. European Stroke Organisation (ESO) Executive Committee; ESO Writing Committee, Cerebrovasc Dis, 2008;25(5):457–507.


64. 65. 66. 67.


Gastmeier P, Sohr D, Geffers C, et al., Antimicrob Agents Chemother, 2009;53(7):2714–18.


Verhamme KM, De Coster W, De Roo L, et al., Infect Control Hosp Epidemiol, 2007;28(4):389–97.


Winstanley TG, Limb DI, Eggington R, Hancock F, J Antimicrob Chemother, 1997;40(4):591–4.


Bonadio M, Meini M, Spitaleri P, Gigli C, Eur Urol, 2001;40:439–45.


Zhanel GG, Hisanaga TL, Laing NM, et al., Int J Antimicrob Agents, 2005;26(5):380–88.


69. Minnerup J, et al., J Neurol Neurosurg Psychiatry, 2010;81(2):198–202.


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