TY - JOUR
T1 - European stroke organisation guideline on stroke-associated pneumonia
AU - Meisel, Andreas
AU - Dziedzic, Tomasz
AU - Dziewas, Rainer
AU - Hussain, Salman
AU - Katan, Mira
AU - Kishore, Amit K.
AU - Papagiannopoulou, Georgia
AU - Podlasek, Anna
AU - Roffe, Christine
AU - Smith, Craig J.
AU - Westendorp, Willeke
N1 - Publisher Copyright:
© The Author(s) 2026. Published by Oxford University Press on behalf of the European Stroke Organisation. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].
PY - 2026/5/7
Y1 - 2026/5/7
N2 - Stroke-associated pneumonia (SAP), which occurs in approximately 12%, is the most frequent infectious complication after acute stroke and a major contributor to morbidity and mortality. Despite its clinical importance, high-quality evidence to guide the diagnosis, prediction, prevention and treatment of SAP remains limited, underscoring the need for structured, consensus-based recommendations in stroke care. This guideline was developed following the standard methodology of the European Stroke Organisation (ESO): an interdisciplinary working group identified 15 clinically relevant questions, conducted systematic literature reviews and meta-analyses, appraised the quality of the available evidence and formulated evidence-based recommendations. Notably, only 3 of 15 questions were supported by predominantly low-quality evidence, and most guideline statements therefore rely on expert consensus rather than evidence-based recommendations. For clinical practice, standardised diagnostic criteria are recommended, while chest CT and plasma C-reactive protein may provide additional diagnostic value. Clinical prediction scores and biomarkers demonstrate moderate to good discriminative performance, However, their routine use will depend on the availability of effective preventive measures. Prevention strategies include positioning, early mobilisation and individualised nutritional approaches. Dysphagia screening and swallowing management are established components of post-stroke care for SAP prevention and are addressed in a separate ESO guideline. Adjunctive therapies are not part of standard care but may be considered in selected patients. Preventive antibiotic therapy is not recommended due to a lack of benefit on SAP incidence or clinical outcomes, whereas empirical antibiotic treatment should be initiated promptly after diagnosis and guided by local protocols targeting aspiration-associated pathogens. In addition, this guideline provides a framework for future randomised trials aimed at improving the evidence base for SAP management.
AB - Stroke-associated pneumonia (SAP), which occurs in approximately 12%, is the most frequent infectious complication after acute stroke and a major contributor to morbidity and mortality. Despite its clinical importance, high-quality evidence to guide the diagnosis, prediction, prevention and treatment of SAP remains limited, underscoring the need for structured, consensus-based recommendations in stroke care. This guideline was developed following the standard methodology of the European Stroke Organisation (ESO): an interdisciplinary working group identified 15 clinically relevant questions, conducted systematic literature reviews and meta-analyses, appraised the quality of the available evidence and formulated evidence-based recommendations. Notably, only 3 of 15 questions were supported by predominantly low-quality evidence, and most guideline statements therefore rely on expert consensus rather than evidence-based recommendations. For clinical practice, standardised diagnostic criteria are recommended, while chest CT and plasma C-reactive protein may provide additional diagnostic value. Clinical prediction scores and biomarkers demonstrate moderate to good discriminative performance, However, their routine use will depend on the availability of effective preventive measures. Prevention strategies include positioning, early mobilisation and individualised nutritional approaches. Dysphagia screening and swallowing management are established components of post-stroke care for SAP prevention and are addressed in a separate ESO guideline. Adjunctive therapies are not part of standard care but may be considered in selected patients. Preventive antibiotic therapy is not recommended due to a lack of benefit on SAP incidence or clinical outcomes, whereas empirical antibiotic treatment should be initiated promptly after diagnosis and guided by local protocols targeting aspiration-associated pathogens. In addition, this guideline provides a framework for future randomised trials aimed at improving the evidence base for SAP management.
KW - aspiration
KW - biomarker
KW - diagnostic criteria
KW - dysphagia
KW - guideline
KW - pneumonia
KW - positioning
KW - preventive antibiotics
KW - scores
KW - stroke
UR - https://www.scopus.com/pages/publications/105038289483
U2 - 10.1093/esj/aakag044
DO - 10.1093/esj/aakag044
M3 - Article
C2 - 42095755
AN - SCOPUS:105038289483
SN - 2396-9873
VL - 11
JO - European Stroke Journal
JF - European Stroke Journal
IS - 5
M1 - aakag044
ER -