TY - JOUR
T1 - Preventive antibiotic therapy in acute stroke patients
T2 - A systematic review and meta-analysis of individual patient data of randomized controlled trials
AU - Westendorp, Willeke F.
AU - Vermeij, Jan-Dirk
AU - Smith, Craig J.
AU - Kishore, Amit K.
AU - Hodsoll, John
AU - Kalra, Lalit
AU - Meisel, Andreas
AU - Chamorro, Angel
AU - Chang, Jason J.
AU - Rezaei, Yousef
AU - Amiri-Nikpour, Mohammad R.
AU - DeFalco, Fabrizio A.
AU - Switzer, Jeffrey A.
AU - Blacker, David J.
AU - Dijkgraaf, Marcel G. W.
AU - Nederkoorn, Paul J.
AU - van de Beek, Diederik
N1 - Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: J.H. is partially supported by National Institute of Health Research NF-SI-0617–10120 and Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the authors and not necessarily those of the UK NHS, NIHR, or the Department of Health and Social Care. Otherwise, this research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Publisher Copyright: © European Stroke Organisation 2021.
PY - 2021/12
Y1 - 2021/12
N2 - Introduction: Infection after stroke is associated with unfavorable outcome. Randomized controlled studies did not show benefit of preventive antibiotics in stroke but lacked power for subgroup analyses. Aim of this study is to assess whether preventive antibiotic therapy after stroke improves functional outcome for specific patient groups in an individual patient data meta-analysis. Patients and methods: We searched MEDLINE (1946–7 May 2021), Embase (1947–7 May 2021), CENTRAL (17th September 2021), trial registries, cross-checked references and contacted researchers for randomized controlled trials of preventive antibiotic therapy versus placebo or standard care in ischemic or hemorrhagic stroke patients. Meta-analysis was performed by a one-step and two-step approach. Primary outcome was functional outcome adjusted for age and stroke severity. Secondary outcomes were infections and mortality. Results: 4197 patients from nine trials were included. Preventive antibiotic therapy was not associated with a shift in functional outcome (mRS) at 3 months (OR1.13, 95%CI 0.98–1.31) or unfavorable functional outcome (mRS 3–6) (OR0.85, 95%CI 0.60–1.19). Preventive antibiotics did not improve functional outcome in pre-defined subgroups (age, stroke severity, timing and type of antibiotic therapy, pneumonia prediction scores, dysphagia, type of stroke, and type of trial). Preventive antibiotics reduced infections (276/2066 (13.4%) in the preventive antibiotic group vs. 417/2059 (20.3%) in the control group, OR 0.60, 95% CI 0.51–0.71, p < 0.001), but not pneumonia (191/2066 (9.2%) in the preventive antibiotic group vs. 205/2061 (9.9%) in the control group (OR 0.92 (0.75–1.14), p = 0.450). Discussion and conclusion: Preventive antibiotic therapy did not benefit any subgroup of patients with acute stroke and currently cannot be recommended.
AB - Introduction: Infection after stroke is associated with unfavorable outcome. Randomized controlled studies did not show benefit of preventive antibiotics in stroke but lacked power for subgroup analyses. Aim of this study is to assess whether preventive antibiotic therapy after stroke improves functional outcome for specific patient groups in an individual patient data meta-analysis. Patients and methods: We searched MEDLINE (1946–7 May 2021), Embase (1947–7 May 2021), CENTRAL (17th September 2021), trial registries, cross-checked references and contacted researchers for randomized controlled trials of preventive antibiotic therapy versus placebo or standard care in ischemic or hemorrhagic stroke patients. Meta-analysis was performed by a one-step and two-step approach. Primary outcome was functional outcome adjusted for age and stroke severity. Secondary outcomes were infections and mortality. Results: 4197 patients from nine trials were included. Preventive antibiotic therapy was not associated with a shift in functional outcome (mRS) at 3 months (OR1.13, 95%CI 0.98–1.31) or unfavorable functional outcome (mRS 3–6) (OR0.85, 95%CI 0.60–1.19). Preventive antibiotics did not improve functional outcome in pre-defined subgroups (age, stroke severity, timing and type of antibiotic therapy, pneumonia prediction scores, dysphagia, type of stroke, and type of trial). Preventive antibiotics reduced infections (276/2066 (13.4%) in the preventive antibiotic group vs. 417/2059 (20.3%) in the control group, OR 0.60, 95% CI 0.51–0.71, p < 0.001), but not pneumonia (191/2066 (9.2%) in the preventive antibiotic group vs. 205/2061 (9.9%) in the control group (OR 0.92 (0.75–1.14), p = 0.450). Discussion and conclusion: Preventive antibiotic therapy did not benefit any subgroup of patients with acute stroke and currently cannot be recommended.
KW - antibiotic therapy
KW - infection
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85118563188&partnerID=8YFLogxK
U2 - https://doi.org/10.1177/23969873211056445
DO - https://doi.org/10.1177/23969873211056445
M3 - Article
C2 - 35342808
SN - 2396-9873
VL - 6
SP - 385
EP - 394
JO - European Stroke Journal
JF - European Stroke Journal
IS - 4
ER -