Diagnosis and treatment of stroke associated pneumonia: Qualitative exploration of clinicians’ practice
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Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, MALAYSIA
Department of Pharmacy Practice, College of Clinical Pharmacy, Hodeidah University, Al Hodeidah, YEMEN
Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, JORDAN
Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, Wales, UK
Department of Biopharmaceutics and Clinical Pharmacy, School of Pharmacy, The University of Jordan, Amman, JORDAN
Online publication date: 2023-01-19
Publication date: 2023-03-01
Electron J Gen Med 2023;20(2):em454
Establishing and implementing a gold standard criteria for diagnosing and treating stroke-associated pneumonia (SAP) would have a significant positive impact on stroke outcomes and antibiotic stewardship. This study aimed to qualitatively explore current diagnostic and treatment practice for SAP among clinicians.

A qualitative study was employed to conduct semi-structured interviews at the tertiary-care Jordan University Hospital. A purposive sampling technique was employed to recruit the participants, including respiratory consultants (n=3) and residents (n=9) practicing in the internal medicine wards and intensive care unit, where stroke patients are treated. The interviews were audio-recorded, transcribed verbatim, translated, and analyzed thematically using framework analysis.

Clinicians expressed their experiences, which were organized into two themes and eight emerged sub-themes: Terminology and diagnostic approach of SAP involved; no definite terminology, reliance on both clinical evidence and X-ray findings to decide, reliance on clinical evidence alone to suspect SAP and initiate empirical therapy, and SAP overdiagnosis. The treatment strategies include early treatment of SAP, treating SAP the same as CAP/HAP, predominant anaerobes coverage, and SAP overtreatment.

Our findings show a wide range of physician-based diagnostic and treatment approaches for SAP, with clinical criteria serving as the main driver for antibiotic initiation. Standard validated algorithmic-based criteria need to be established and implemented.

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