Oral hygiene is independently associated with early stroke-associated pneumonia in hospitalized patients with ischemic stroke: An observational study

Stroke-associated pneumonia (SAP) is a major stroke complication. Oral microorganisms are important contributors to SAP. Here, we aimed to investigate whether oral hygiene is associated with early SAP (<72 h of stroke onset) in patients with ischemic stroke. We performed an observational study of 331 patients with acute ischemic stroke from 2 medical centers. A series of assessments were performed to evaluate the neurological status, Beck Oral Assessment Scale (BOAS), and habits of oral hygiene. Univariate and binary logistic regression analyses were conducted to identify the risk factors for early SAP. Potentially relevant factors for oral hygiene in patients with early SAP and general ischemic stroke were also analyzed. Older age, higher prevalence of coronary heart disease, dysphagia and feeding with stomach tube, shorter course of disease as well as severe neurological impairments (such as National Institutes of Health Stroke Scale and Mini-Mental State Examination) were occurred in patients with early SAP (vs non-SAP, all P < .05). After adjusting for confounders, the analysis showed that BOAS score (odds ratio [OR] = 1.972, 95% confidence interval [CI] [1.479, 2.630], P < .001) and National Institutes of Health Stroke Scale (OR = 1.322, 95% CI [1.211, 1.443], P < .001) were independent risk factors for early SAP (OR = 1.678, P = .001). The correlation between BOAS scores and potential variables showed sex-dependent differences in patients with early SAP (all P < .05). The severity of neurologic impairment, age, and number of dental caries may be factors that influence abnormal BOAS scores (vs normal BOAS scores, all P < .05). Abnormal oral hygiene was an independently associated factor in the assessment of early SAP. Emphasis on the relevant influences on oral health may be a nursing strategy for reducing the occurrence of SAP.