OBJECTIVE  To explore the distribution of high-risk populations, key departments and critical exposure factors for hospital-associated infections among stroke inpatients in a three-A hospital, and to elucidate their epidemiological characteristics.

METHODS  A retrospective analysis was conducted on the clinical data of 12 552 stroke inpatients admitted to Lishui People's Hospital, Zhejiang Province, from Jan. 2015 to Dec. 2024. Data on hospital-associated infections and etiological characteristics were analyzed.

RESULTS  From 2015 to 2024, a total of 391 stroke inpatients developed hospital-associated infections （3.12%）, a rate significantly higher than the hospital-wide inpatient rate （P＜0.001）. The departments with the highest infection rates were the intensive care unit （8.62%）, rehabilitation medicine （7.28%） and neurosurgery （5.86%）. Patients with subarachnoid hemorrhage had the highest infection rate （P＜0.001）. The infection rate was higher in patients hospitalized for ≥2 weeks compared to those hospitalized for ＜2 weeks （P＜0.001）. Patients undergoing invasive procedures had a higher infection rate （P＜0.001）. Among infected patients, hypertension was the most common comorbidity （69.05%）, followed by diabetes mellitus （21.48%）, hyperhomocysteinemia （20.97%）, atrial fibrillation （17.90%） and coronary atherosclerotic heart disease （14.07%）. Lower respiratory tract infection was the predominant type of hospital-associated infection （53.17%）, followed by bacteremia （16.23%） and urinary tract infection （9.14%）. A total of 445 pathogenic strains were identified, including 292 gram-negative bacteria （65.62%）, 121 gram-positive bacteria （27.19%） and 32 fungi （7.19%）. The top five pathogenic bacteria were Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli.

CONCLUSIONS  The overall hospital-associated infection rate among stroke inpatients from 2015 to 2024 is stable, with higher rates observed in elderly and male patients, particularly those with subarachnoid hemorrhage. The most common comorbidities are hypertension and diabetes mellitus. The departments with the highest infection rates are the intensive care unit, rehabilitation medicine and neurosurgery. The most frequent infection site is the lower respiratory tract, and gram-negative bacteria are the predominant pathogens.