***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose — Pneumonia has been estimated to occur in about one third of patients after acute stroke . Only limited data are available on stroke-associated pneumonia ( SAP ) in specialized neurological intensive care units ( NICUs ) . Methods — We enrolled 124 patients with acute stroke who were treated at our university hospital NICU in a prospect i ve observational study . Incidence rates and risk factors of SAP and long-term clinical outcome were determined . Results — SAP incidence was 21 % with a spectrum of pathogens , which is comparable to previously published data on general ICU patients . Mechanical ventilation , multiple location , and vertebrobasilar stroke , as well as dysphagia and abnormal chest x-ray findings , were identified as risk factors for the disease . SAP patients showed higher mortality rates than nondiseased subjects ( acute , 26.9 % versus 8.2 % ; long-term , 35.3 % versus 14.3 % ) and a significantly poorer long-term clinical outcome ( Barthel Index , 50.5±42.4 versus 81.5±27.8 ; Rankin Scale , 3.5±1.7 versus 2.2±1.6 ) . Conclusions — Our data underline the considerable epidemiological and prognostic impact of SAP for the treatment of acute stroke patients in a specialized NICU setting . They demonstrate that the occurrence of SAP deteriorates clinical outcome in these patients . Our results allow us to identify high-risk stroke patients at time of NICU admission in whom the use of preventive treatment strategies is most promising BACKGROUND Urinary tract infection ( UTI ) is a recognized complication of stroke . We aim ed to determine the incidence of UTI after acute stroke , the risk factors associated with this complication , and its association with outcome . METHODS Prospect i ve study of consecutive acute stroke patients admitted to an urban teaching hospital . Routine clinical assessment included the modified National Institutes of Health Stroke Scale ( mNIHSS ) and modified Rankin scale ( mRS ) . Patients were followed up for 3 months , including recording of clinician diagnosis of UTI . RESULTS We studied 412 patients ; 65 ( 15.8 % ) were diagnosed with UTI , at a median of 14 days ( IQR = 4 - 39 ) post-stroke . In a binomial multivariate regression analysis , UTI was associated with urinary catheterization ( OR = 3.03 , 95 % CI 1.41 - 6.52 ) , higher mRS ( OR = 1.85 , 1.29 - 2.64 ) and increasing age ( OR = 1.51 , 1.13 - 2.00 for each decade ) . UTI was associated with death or disability at 3 months , however , this link was attenuated and became non-significant when measures of stroke severity and pre-stroke morbidity were included in a multivariate analysis . CONCLUSION UTI is common after acute stroke . It is associated with urinary catheterization , post-stroke disability and increasing age . Avoidance of catheterization might reduce the incidence of this common complication Background : We have recently shown that ischemic stroke causes a stress-mediator-induced long-lasting immunodepressive state in mice . Methods : Using head magnetic resonance imaging and st and ardized immunoassays , we prospect ively investigated whether poststroke immunodepression is also seen in humans . Results : Compared to healthy volunteers ( n = 30 ) , a rapid depression of lymphocyte counts and a functional deactivation of monocytes and T helper type 1 cells was observed in acute stroke patients ( SP ; n = 40 ) . Immunodepression was more pronounced in patients with severe clinical deficit or large infa rct ion . On admission the combination of monocytic tumor necrosis factor α release ex vivo and the National Institute of Health Stroke Scale score were the best predictors for nosocomial infection , preferentially affecting older SP . Conclusion : Our data provide evidence for an immediate suppression of cell-mediated immune responses after ischemic stroke in humans Background Pneumonia is a major risk factor of death after acute stroke . In a mouse model , preventive antibacterial therapy with moxifloxacin not only prevents the development of post-stroke infections , it also reduces mortality , and improves neurological outcome significantly . In this study we investigate whether this approach is effective in stroke patients . Methods Preventive ANtibacterial THERapy in acute Ischemic Stroke ( PANTHERIS ) is a r and omized , double-blind , placebo-controlled trial in 80 patients with severe , non-lacunar , ischemic stroke ( NIHSS>11 ) in the middle cerebral artery ( MCA ) territory . Patients received either intravenous moxifloxacin ( 400 mg daily ) or placebo for 5 days starting within 36 hours after stroke onset . Primary endpoint was infection within 11 days . Secondary endpoints included neurological outcome , survival , development of stroke-induced immunodepression , and induction of bacterial resistance . Findings On intention-to treat analysis ( 79 patients ) , the infection rate at day 11 in the moxifloxacin treated group was 15.4 % compared to 32.5 % in the placebo treated group ( p = 0.114 ) . On per protocol analysis ( n = 66 ) , moxifloxacin significantly reduced infection rate from 41.9 % to 17.1 % ( p = 0.032 ) . Stroke associated infections were associated with a lower survival rate . In this study , neurological outcome and survival were not significantly influenced by treatment with moxifloxacin . Frequency of fluoroquinolone resistance in both treatment groups did not differ . On logistic regression analysis , treatment arm as well as the interaction between treatment arm and monocytic HLA-DR expression ( a marker for immunodepression ) at day 1 after stroke onset was independently and highly predictive for post-stroke infections . Interpretation PANTHERIS suggests that preventive administration of moxifloxacin is superior in reducing infections after severe non-lacunar ischemic stroke compared to placebo . In addition , the results emphasize the pivotal role of immunodepression in developing post-stroke infections . Trial Registration Controlled-Trials.com IS RCT Background — Pneumonia is an important complication of ischemic stroke and increases mortality 3-fold . Five guidelines recommend a dysphagia screen before oral intake . What constitutes an adequate dysphagia screen and which patients should receive it remain unclear . Methods — Fifteen acute care institutions prospect ively collected data on all admitted patients with acute ischemic stroke . Sites were required to collect data on demographics and 4 quality indicators . Optional data included stroke severity and complications . We measured adherence to a screen for dysphagia  , the type of screen , and development of in-hospital pneumonia . Results — Between December 2001 and January 2003 , 2532 cases were collected .  In-hospital complications were recorded on 2329 ( 92 % ) of cases . Stroke severity was captured on 1361 ( 54 % ) . Adherence to a  dysphagia screen  was 61 % . Six sites had a formal dysphagia screen , and their adherence rate was 78 % compared with 57 % at sites with no formal screen . The pneumonia rate at sites with a formal dysphagia screen was 2.4 % versus 5.4 % ( P=0.0016 ) at sites with no formal screen . There was no difference in median stroke severity ( 5 versus 4 ; P=0.84 ) between the sites with and without a formal screen . A formal dysphagia screen prevented pneumonia even after adjusting for stroke severity . Conclusions — A formal dysphagia screen is associated with a higher adherence rate to dysphagia screens and a significantly decreased risk of pneumonia . A formal screening protocol should be offered to all stroke patients , regardless of stroke severity The third most common stroke complication is infection . We studied the rates of aspiration pneumonia and urinary tract infection ( UTI ) , their risk factors and their effect on outcome in the  1455 Glycine Antagonist ( Gavestinel ) in Neuroprotection ( GAIN ) International patients with ischaemic stroke . Forward stepwise logistic regression and Cox proportional hazards modelling identified baseline factors that predicted events and the independent effect of events up to day 7 on poor stroke outcome at 3 months in patients alive at day 7 , after correcting for prognostic factors . Higher baseline National Institute of Health Stroke Scale ( NIHSS ) and age , male gender , history of diabetes and stroke subtype predicted pneumonia , which occurred in 13.6 % of patients . Female gender and higher baseline NIHSS and age predicted UTI , which occurred in 17.2 % of patients . Pneumonia was associated with poor outcome by mortality ( hazard ratio , 2.2 ; 95 % confidence interval , 1.5 - 3.3 ) , Barthel index ( < 60 ) ( odds ratio , 3.8 ; 2.2 - 6.7 ) , NIHSS ( 4.9 ; 1.7 - 14 ) and Rankin scale ( > /=2 ) ( 3.4 ; 1.4 - 8.3 ) . UTI was associated with Barthel index ( 1.9 ; 1.2 - 2.9 ) , NIHSS ( 2.2 ; 1.2 - 4.0 ) and Rankin scale ( 3.1 ; 1.6 - 4.9 ) . Pneumonia and UTI are independently associated with stroke poor outcome .  Patients with identified risk factors must be closely monitored for infection Background and Purpose — Moderate hypothermia decreases ischemic damage in experimental stroke models . This multicenter study was performed to evaluate ( 1 ) the safety and feasibility of moderate hypothermia and ( 2 ) its potential to reduce intracranial hypertension in acute stroke patients . Methods — Fifty prospect i ve patients with cerebral infa rct ion involving at least the complete middle cerebral artery territory treated with moderate hypothermia were evaluated .  Hypothermia was induced with the use of cooling blankets as well as alcohol and ice bags within 22±9 hours after stroke onset and maintained for 24 to 72 hours ; subsequently , patients passively rewarmed over a mean duration of 17 hours . Outcome was assessed at 4 weeks and at 3 months . Results — Time required for cooling to < 33 ° C varied from 3.5 to 11 hours . The most frequent complications of hypothermic therapy were thrombocytopenia ( 70 % ) , bradycardia ( 62 % ) , and pneumonia ( 48 % ) . Four patients ( 8 % ) died during hypothermia as a result of severe coagulopathy , cardiac failure , or uncontrollable intracranial hypertension . An additional 15 patients ( 30 % ) died during or after rewarming because of rebound increase in intracranial pressure ( ICP ) and fatal herniation . A shorter ( < 16 hours ) rewarming period was associated with a more pronounced rise of ICP . Elevated ICP values were significantly reduced under  hypothermia . Neurological outcome according to the National Institutes of Health Stroke Scale score 4 weeks after stroke was 29 , and Rankin Scale score 3 months after stroke was 2.9 . Conclusions — Moderate hypothermia is feasible in patients with acute stroke , although it is associated with several side effects . Most deaths occur during rewarming as a result of excessive ICP rise . Our preliminary observation that a longer duration of the rewarming period limits the ICP increase remains to be confirmed in future studies Rationale Stroke is a leading cause of death worldwide . Fever after stroke is a strong predictor of a poor outcome . Infections occur in up to 40 % of patients with stroke and have also been associated with poor outcomes . Preventive antibiotic therapy lowers the infection rates in patients after stroke , as shown in a recent meta- analysis of r and omised studies . Phase III trials evaluating the effect of antibiotic prophylaxis on clinical outcomes in sufficient numbers of patients with stroke have , however , not been performed to date . Ceftriaxone , an off-patent medicine , is an antibiotic with a broad defence against the bacteria that cause the most common infections after stroke . Preventive antibiotic therapy with ceftriaxone may potentially reduce poor outcome after acute stroke and , therefore , a r and omised clinical trial is warranted . Aim The aim of the present study is to investigate whether the preventive use of the antibiotic ceftriaxone improves functional outcome in patients with stroke . Design We will conduct a multicentre prospect i ve , r and omised , open-label , blinded end point trial of st and ard care with preventive ceftriaxone treatment and compare it with st and ard care without preventive ceftriaxone .  Study Adult patients with stroke ( both ischaemic and haemorrhagic ) and a score ≥1 on the National Institutes of Health Stroke Scale will be included . The 3200 patients will be r and omly assigned to two groups of 1600 patients . One group will receive st and ard care and ceftriaxone at a dose of 2 g , given every 24 h intravenously for four-days , and the other group will receive stroke-unit care without preventive antibiotic treatment . Outcomes The primary end point will be functional outcome at a three-month follow-up on the modified Rankin Scale , dichotomised as a favourable outcome ( 0–2 ) or an unfavourable outcome ( 3–6 ) . Secondary outcome measures will be death rate at discharge and three-months , infection rate during hospital admission , length of hospital admission , volume of poststroke care , use of antibiotics during the three-month follow-up , functional outcome using the 
    Output:
    
Our study stresses the need to prevent infections in patients with stroke