Severe Pneumonia in High Cervical Spinal Cord Injury: Clinical Features and Outcomes

Introduction: This research investigated the clinical features, distribution of pathogens, treatment outcomes, and prognosis of patients suffering from high cervical spinal cord injury (HSCI) who also have severe pneumonia. In particular, studies have focused on the relationship between alterations in respiratory mechanics due to nerve damage and infections caused by multidrug-resistant bacteria. Methods A retrospective analysis was conducted on the clinical records of nine individuals suffering from high rates of cervical spinal cord injuries at levels C2 to C6, who also experienced severe pneumonia. These patients were treated at Guangxi Jiangbin Hospital between 2020 and 2023, and a review of pertinent literature from the last five years was performed. Results The average age of the patients was 60 years, with a median duration of mechanical ventilation of 28 days. Among the causes, gram-negative bacteria were responsible for 88.9% of the cases, and there was a notable prevalence of multidrug-resistant organisms, including Acinetobacter baumannii and Klebsiella pneumoniae. The initial success rate of antibiotic therapy was merely 33.3%, which improved to 55.6% following modifications to the treatment plan. Within 28 days, 33.3% of patients were able to discontinue antibiotics, while the 90-day mortality rate was 44.4%. Patients with complete injuries exhibited a significantly greater requirement for mechanical ventilation. Conclusion Individuals suffering from HSCI alongside severe pneumonia endure significant challenges related to mechanical ventilation, including elevated rates of infections and fatalities due to antibiotic-resistant pathogens. Consequently, it is crucial to assess respiratory capabilities promptly, prioritize pathogen identification, and create a comprehensive weaning approach for these patients.