Stroke-Associated Infections after Mechanical Thrombectomy: Analysis of the Stroke-Associated INfection afTer Mechanical Thrombectomy (SAINT-MT) Study.

INTRODUCTION

Despite the established benefit of mechanical thrombectomy (MT), data on the incidence, risk factors, and longer-term outcomes of stroke-associated infections (SAIs) in this population remain limited. This retrospective, single-centre cohort study evaluated the frequency of SAI, associated variables, and longer-term mortality post-MT.

METHODS

Data for acute ischaemic stroke patients undergoing MT at Manchester Centre for Clinical Neurosciences were extracted from the Sentinel Stroke National Audit Programme (April 2016-March 2024) and linked to electronic patient records. Routinely collected admission and procedural variables were analysed. Primary outcome measures were the proportion of patients developing SAI and subtypes of SAI post-MT. Multifactorial regression analysis was performed to evaluate associations between clinical variables and SAI and also between SAI and 1-year mortality.

RESULTS

Of 589 patients, 179 (30%) developed SAI. Stroke-associated pneumonia (SAP) accounted for 73% of SAI (131 cases, 22% of patients); urinary tract infections comprised 9%. Admission NIHSS, dysphagia, C-reactive protein (CRP), neutrophil-lymphocyte ratio, and premorbid mRS were independently associated with SAI (p < 0.05). Similar associations were observed for SAP, though CRP association was attenuated. Crude 1-year mortality was higher in patients with SAI (34%, 60/179), including those with SAP (36%, 47/131), compared with 12% (49/410) in non-SAI patients. However, multivariable regression did not reach statistical significance.

CONCLUSIONS

SAI occurred in nearly one-third of patients post-MT, predominantly as SAP. While crude mortality was increased with SAI, adjusted analyses were non-significant. Several variables were independently associated with SAI, enabling opportunities for identification of high-risk patients for enhanced monitoring or preventive strategies.