PURPOSE: Pneumoccocal infections after stroke have high incidence and mortality. In elderly patients, meta-analyses have shown a protective effect of the 23-valent pneumococcal polysaccharide vaccine (PPV) against invasive pneumococcal disease while studies examining pneumonia case fatality rates are inclusive. Accordingly, the Centers for Disease Control (CDC) recommends that PPV be given to adults 65 and older and those with chronic diseases. The study aimed to explore if PPV was associated with a reduction in 30 and 60-day mortality among stroke patients, a portion of which was likely related to Streptococcus pneumoniae infection.
METHODS: Short-Stay records from the Medicare Provider Analysis and Review, 2007, were used to create a retrospective cohort. 301,929 unique in-patient admissions with a diagnosis of cerebrovascular disease International Classification of Disease Version (ICD-9 430-438.9) and without a diagnosis of pneumonia or lower respiratory track infections were identified for analysis. Vaccinated cases (n=2023) were defined by the presence of ICD-9 codes V03.82 and 995.2. A multiple regression using Cox proportional hazard model (adjusted for age, sex, race, influenza vaccination status, comorbidities, stroke type, stroke severity and accounting for potential misclassification bias, procedures to the airway, and a quality of care index) was used to assess mortality risk at 30 and 60 days after stroke admission.
RESULTS: A 16% reduction in mortality (HR = 0.84) was observed in the vaccinated group at 30 (p=0.002, 95% CI: 0.75-0.93) and 60 days (p=0.004, 95% CI: 0.75-0.94).
CONCLUSION: This study suggests that PPV might reduce pneumococcal-associated mortality among patients recently hospitalized for stroke.
CLINICAL IMPLICATIONS: While current CDC guidelines endorse PPV vaccination for older adults, the impact of these recommendations in post-stroke patients has not been fully evaluated. The results suggest that PPV could reduce mortality in this population. Therefore, vaccination against pneumococcal infections should be assessed as a new standard of care for patients admitted for acute stroke.
DISCLOSURE: Scottie Bussell, No Financial Disclosure Information; No Product/Research Disclosure Information