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Supplemental material, sj-docx-1-eso-10.1177_23969873221136927 for Molecular biomarkers predicting newly detected atrial fibrillation after ischaemic stroke or TIA: A systematic review by Kirsty Ward, Andy Vail, Alan Cameron, Mira Katan, Gregory YH Lip, Jesse Dawson, Craig J Smith and Amit K Kishore in European Stroke Journal

Supplemental material, sj-pdf-1-wso-10.1177_17474930211045880 for Use of risk scores for predicting new atrial fibrillation after ischemic stroke or transient ischemic attack—A systematic review by Amit K Kishore, Mohammad J Hossain, Alan Cameron, Jesse Dawson, Andy Vail and Craig J Smith in International Journal of Stroke

Supplemental material, sj-pdf-1-eso-10.1177_2396987316651759 for Clinical risk scores for predicting stroke-associated pneumonia: A systematic review by Amit K Kishore, Andy Vail, Benjamin D Bray, Angel Chamorro, Mario Di Napoli, Lalit Kalra, Peter Langhorne, Joan Montaner, Christine Roffe, Anthony G Rudd, Pippa J Tyrrell, Diederik van de Beek, Mark Woodhead, Andreas Meisel and Craig J Smith in European Stroke Journal

Background and Purpose— Identifying the causal pathogens of pneumonia complicating stroke is challenging, and antibiotics used are often broad spectrum, without recourse to the microbiological cause. We aimed to review existing literature to identify organisms responsible for pneumonia complicating stroke, before developing a consensus-based approach to antibiotic treatment. Methods— A systematic literature review of multiple electronic databases using predefined search criteria was undertaken, in accordance with Cochrane and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Published studies of hospitalized adults with ischemic stroke, intracerebral hemorrhage, or both, which identified microbiological etiologies for pneumonia complicating stroke up to January 1, 2017, were considered. Analysis included summary statistics and random-effects meta-analysis where appropriate. Results— Fifteen studies (40% ischemic stroke, 60% ischemic stroke and intracerebral hemorrhage) involving 7968 patients were included. Reported occurrence of pneumonia varied considerably between studies (2%–63%) with a pooled frequency of 23% (95% confidence interval, 14%–34%; I 2 =99%). Where reported (60%), the majority of pneumonia occurred within 1 week of stroke (78%). Reported frequency of positive culture data (15%–88%) varied widely. When isolated, aerobic Gram-negative bacilli (38%) and Gram-positive cocci (16%) were most frequently cultured; commonly isolated organisms included Enterobacteriaceae (21.8%: Klebsiella pneumoniae , 12.8% and Escherichia coli , 9%), Staphylococcus aureus (10.1%), Pseudomonas aeruginosa (6%), Acinetobacter baumanii (4.6%), and Streptococcus pneumoniae (3.5%). Sputum was most commonly used to identify pathogens, in isolation (40%) or in conjunction with tracheal aspirate (15%) or blood culture (20%). Conclusions— Although the analysis was limited by small and heterogeneous study populations, limiting determination of microbiological causality, this review suggests aerobic Gram-negative bacilli and Gram-positive cocci are frequently associated with pneumonia complicating stroke. This supports the need for appropriately designed studies to determine microbial cause and a consensus-based approach in antibiotic usage and further targeted antibiotic treatment trials for enhanced antibiotic stewardship.

Background and PurposeIdentifying the causal pathogens of pneumonia complicating stroke is challenging and antibiotics used are often broad spectrum, without recourse to the microbiological etiology. We aimed to review existing literature to identify organisms responsible for pneumonia complicating stroke, prior to developing a consensus based approach to antibiotic treatment. MethodsA systematic literature review of multiple electronic databases was undertaken, in accordance with Cochrane and PRISMA guidance. Published studies of hospitalised stroke patients, which identified microbiological etiologies for pneumonia complicating stroke up to 1stJanuary 2017, were considered. Analysis included summary statistics and random-effects meta-analysis where appropriate.Results15 studies (40% IS, 60% IS and ICH) involving 7968 patients were included. Where reported (60%), the majority of pneumonia occurred within 1 week of stroke (78%). Reported frequency of positive culture data (15% to 88%) varied widely. When isolated, aerobic Gram negative bacilli (AGNB, 38%) and Gram positive cocci (GPC, 16%) were most frequently cultured; commonly isolated organisms included Enterobacteriaceae (21.8%: Klebsiella pneumoniae, 12.8% and Escherichia coli, 9%), Staphylococcus aureus (10.1%), Pseudomonas aeruginosa (6%), Acinetobater baumanii (4.6%) and Streptococcus pneumoniae (3.5%). Sputum was most commonly used to identify pathogens, in isolation (40%) or in conjunction with tracheal aspirate (15%) or blood culture (20%).ConclusionsWhilst analysis was limited by small and heterogeneous study populations, limiting determination of microbiological causality, this review suggests AGNB and GPC are frequently associated with pneumonia complicating stroke. This supports the need for a consensus based approach in antibiotic usage and further targeted antibiotic treatment trials for enhanced antibiotic stewardship.