Smith et al reported criteria for the diagnosis of stroke-associated pneumonia derived by the PISCES group. This is a modification of the CDC-NHSN criteria for health care-associated infection. The authors are from multiple institutions in Europe and are members of the Pneumonia in Stroke Consensus Group (PISCES).
Patient selection: history of recent stroke
Criteria for stroke-associated pneumonia - all of the following:
(1) >= 1 of the following:
(1a) fever (> 38°C) with no other cause
(1b) WBC < 4,000 per µL OR WBC > 12,000 per µL
(1c) age >= 70 years AND altered mental status AND no other recognized cause
(2) >= 2 of the following
(2a) new onset of purulent sputum OR change in character of sputum over 24 hour period OR increased respiratory secretions OR increased suctioning requirements
(2b) new onset or worsening of: cough OR dyspnea or tachypnea (respiratory rate > 25 breaths per minute)
(2c) rales, crackles or bronchial breath sounds
(2d) worsening gas exchange (increased oxygen requirements OR Pa/FIO2 <= 240)
(3) one of the following:
(3a) >= 2 serial chest radiographs AND >= 1 of the following: new infiltrate, progressive infiltrate, persistent infiltrate, consolidation, cavitation
(3b) no history of cardiac or pulmonary disease AND >= 1 serial chest radiographs AND >= 1 of the following: new infiltrate, progressive infiltrate, persistent infiltrate, consolidation, cavitation
