J Neurol Neurosurg Psychiatry 83:1225-1230 doi:10.1136/jnnp-2012-302194
  • Cerebrovascular disease
  • Research paper

Decision-making in the diagnosis and treatment of stroke-associated pneumonia

  1. Andreas Meisel1,2,3
  1. 1NeuroCure Clinical Research Center (NCRC), Charité—Universitaetsmedizin Berlin, Berlin, Germany
  2. 2Center for Stroke Research Berlin (CSB), Charité—Universitaetsmedizin Berlin, Berlin, Germany
  3. 3Department of Neurology, Charité—Universitaetsmedizin Berlin, Berlin, Germany
  1. Correspondence to Dr Hendrik Harms, NeuroCure Clinical Reseach Center (NCRC), Center for Stroke Research Berlin (CSB), Department of Neurology, Charité—Universitaetsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany; hendrik.harms{at}
  1. Contributors HH: conception and design, analysis and interpretation, drafting and revising the article, final approval, corresponding author. SH: conception, revising the article. UM: analysis and interpretation of data. SO: drafting and revising the article. PH: drafting and revising the article, interpretation of data. AM: conception and design, analysis and interpretation, final approval.

  • Received 5 January 2012
  • Revised 26 July 2012
  • Accepted 27 July 2012
  • Published Online First 28 September 2012


Background Stroke-associated pneumonia (SAP) is associated with impaired outcome in acute stroke patients. Current European and American guidelines for acute stroke care are lacking standardised recommendations for the management of SAP. We investigated current diagnostic and treatment practice for SAP in German stroke units (SU).

Methods We developed a standardised questionnaire including characteristics of SU, questions related to antibiotic treatment approaches of SAP and five case vignettes describing relevant clinical scenarios based on Centers for Disease Control and Prevention (CDC) criteria for ‘clinically defined pneumonia’. All certified German SU were invited to take part in the survey.

Results The survey took place from April to August 2010. Of all 162 German SU contacted, 83 (51%) responded. Classification and regression trees analysis suggested that SAP was diagnosed on the basis of clinical criteria such as fever and stroke severity. Chest x-ray showed only limited influence on the diagnosis of SAP. C-reactive protein was frequently requested as additional diagnostic information (38–76%). Group 3 cephalosporines and (acyl-) aminopenicillins/β-lactamase inhibitors are the most frequently used antibiotics (46–60%) in empiric mono (58%) and combination (42%) therapy. A minority of SU (5%) use prophylactic antibiotic treatment. Standardised procedures are available in 61% of SU.

Conclusion Clinical criteria were the main determinants for SAP diagnosis. In contrast, chest x-ray—the central diagnostic item in CDC criteria—was of minor importance. Our survey demonstrates heterogeneous diagnostic and therapeutic strategies in German SU. Future studies need to establish and to evaluate standardised criteria for SAP care.


  • Funding This study was supported by the European Union's Seventh Framework Programme (FP7/2008-2013) under grant agreements 201024 and 202213 (European Stroke Network), the Helmholtz Gemeinschaft für Forschungseinrichtungen (SO-022NG), the German Ministry for Health and Education (01 EO 08 01), and the Deutsche Forschungsgemeinschaft (Exc 257 NeuroCure).

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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