Diagnosis and Treatment of Stroke-Associated Pneumonia

Kishore, Amit

Abstract

Background: Pneumonia complicating acute stroke results in poorer outcomes. However, substantial inconsistencies exist in terminology, diagnosis, risk stratification, microbiological causes, and antibiotic treatment of stroke-associated pneumonia (SAP).

Aims: This thesis aims to address key gaps around SAP diagnosis, risk prediction, microbiology, and treatment.

Methods: Several systematic reviews were conducted to synthesise evidence on: clinical diagnostic criteria used for SAP (Kishore et al., 2015); prediction models for SAP (Kishore et
al., 2016); and microbiological causes of SAP (Kishore et al., 2018). A prospective multi-centre study assessed the diagnostic utility of chest X-ray versus CT scanning for SAP (Kishore et al.,
2021). International consensus initiatives were undertaken to develop standardised clinical diagnostic criteria (Smith et al., 2015); and antibiotic treatment recommendations for SAP (Kishore et al., 2019).
Results: The reviews found highly variable terminology and criteria used for diagnosing SAP(Kishore et al., 2015) and identified validated clinical prediction models requiring further evaluation (Kishore et al., 2016). Common microbiological causes appear to be Gram-negative
bacteria and Gram-positive cocci (Kishore et al., 2018). Chest X-ray had low accuracy compared to CT scanning for SAP diagnosis, with potential over-diagnosis (Kishore et al.,2021). Consensus initiatives established standardised modified CDC criteria for SAP diagnosis(Smith et al., 2015) and proposed empirical antibiotic strategies based on SAP onset (Kishore et al., 2019).

Conclusions: This thesis contributes to the body of knowledge on SAP by establishing consistent terminology and clinical diagnostic criteria, evaluating diagnostic imaging tests, summarising risk prediction models and microbiological data, and informing standardised
antibiotic treatment recommendations for SAP. These candidate's original contributions have helped advanced the evidence base and addressed critical knowledge gaps around SAP diagnosis
and management. The findings provide a foundation informing future research priorities and translation into clinical practice

• Thesis Type: Thesis
• Deposit Date: Oct 22, 2024
• Award Date: Nov 21, 2024