Stroke-associated pneumonia: pathophysiology, diagnosis and management strategies

Abstract Stroke-associated pneumonia (SAP) is a common and serious complication occurring within 7 days after acute ischemic stroke, significantly impacting patient morbidity, mortality and healthcare costs. Its pathogenesis involves both neurological impairment and stroke-induced immunodepression. Risk factors include advanced age, male sex, stroke severity, impaired consciousness, and comorbidities. Diagnosis remains challenging due to non-specific symptoms and overlapping presentations with other post-stroke complications. The Pneumonia in Stroke Consensus (PISCES) group recommends modified centers for disease control and prevention (CDC) criteria to classify SAP as ‘probable’ or ‘definite’. Several risk prediction scores and emerging biomarkers show potential for early detection but lack broad validation. Effective management emphasises early screening for dysphagia, while preventive strategies like oral hygiene and postural adjustments, along with timely initiation of tailored antibiotic therapy, are crucial for managing infections which can improve patient outcomes.