Schizophrenia, but not depression or bipolar affective disorder, adds additional risk of aspiration pneumonia among stroke survivors: A national cohort study in Taiwan.

OBJECTIVE: Few studies have assessed the sex-specific and age-specific risk of aspiration pneumonia (AP) in patients with stroke and evaluated whether mental disorders may increase this risk. In this population-based cohort study, we investigated the sex-specific and age-specific risk of AP in association with stroke and the joint effects of stroke and mental disorders on the risk of AP. METHODS: We included 23,288 patients with incident stroke admitted between 2005 and 2017 and 68,675 matched nonstroke controls. Information on mental disorders was obtained from medical claims data within the 3 years before the stroke incidence. Cox proportional hazards models considering death as a competing risk event were constructed to estimate the hazard ratio of AP incidence by the end of 2018 associated with stroke and selected mental disorders. RESULTS: After ≤14 years of follow-up, AP incidence was higher in the patients with stroke than in the controls (11.30/1000 vs. 1.51/1000 person-years), representing a covariate-adjusted subdistribution hazard ratio (sHR) of 3.64, with no significant sex difference. The sHR significantly decreased with increasing age in both sexes. Stratified analyses indicated schizophrenia but not depression or bipolar affective disorder increased the risk of AP in the patients with stroke. CONCLUSION: Compared with their corresponding counterparts, the patients with schizophrenia only, stroke only, and both stroke and schizophrenia had a significantly higher sHR of 4.01, 5.16, and 8.01, respectively. The risk of AP was higher in younger stroke patients than those older than 60 years. Moreover, schizophrenia was found to increase the risk of AP in patients with stroke.

Antimicrobial resistance of bacterial isolates from respiratory care wards in Taiwan: a horizontal surveillance study.

A horizontal surveillance study was conducted to identify common bacteria and mycobacteria from 611 respiratory aspirates and 165 urinary samples from 611 patients hospitalised at 17 respiratory care wards (RCWs) in Taiwan. Some major resistance phenotypes, including methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis, and multidrug-resistant Pseudomonas aeruginosa (MDR-PA) and Acinetobacter baumannii (MDR-AB), were identified. Pulsotypes of ESBL-producing P. mirabilis isolates were determined by pulsed-field gel electrophoresis. The prevalences of MRSA, ESBL-producing E. coli (K. pneumoniae and P. mirabilis), carbapenem-resistant (resistant to imipenem and meropenem) P. aeruginosa, MDR-PA, carbapenem-resistant A. baumannii and MDR-AB were, respectively, 86.7%, 20.0% (50.7% and 24.1%), 18.4%, 1.2%, 32.1% and 8.9% for respiratory aspirates and 100%, 25.4% (27.3% and 25.0%), 48.3%, 10.3%, 50.0% and 21.4% for catheterised urinary samples. Among the 44 respiratory isolates of P. mirabilis with an ESBL phenotype, 22 different pulsotypes (>80% identity) were identified. Among 103 isolates of mycobacteria, 90 (87.4%) belonged to rapidly growing mycobacteria and 4 (4%) were Mycobacterium tuberculosis. Among the 404 patients with available clinical information, true infections were found in 28.0%, the most prevalent of which were urinary tract infection (20.5%) and ventilator-associated pneumonia (10.9%). High prevalences of various multidrug-resistant bacteria among the respiratory and urinary tracts of patients present a clinical difficulty in choosing empirical antibiotic treatment in RCWs.