Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials.

Autor:	Westendorp WF; Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands., Vermeij JD; Department of Neurology, Sint Franciscusziekenhuis, Heusden-Zolder, Belgium., Smith CJ; Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK., Kishore AK; Manchester Centre for Clinical Neurosciences, Geoffrey Jefferson Brain Research Centre, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust, Salford, UK.; Division of Cardiovascular Sciences, Lydia Becker Institute of Immunology and Inflammation, University of Manchester, Manchester, UK., Hodsoll J; Biostatistics Department, NIHR Biomedical Research Centre for Mental Health and Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK., Kalra L; Clinical Neurosciences, King's College Hospital NHS Foundation Trust, London, UK., Meisel A; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology with Experimental Neurology, NeuroCure Clinical Research Center, Center for Stroke Research Berlin, Berlin, Germany., Chamorro A; Comprehensive Stroke Center, Department of Neuroscience, Hospital Clinic, University of Barcelona and August Pi I Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain., Chang JJ; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA., Rezaei Y; Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Science, West Azerbaijan, Iran., Amiri-Nikpour MR; Department of Neurology, Urmia University of Medical Sciences, West Azerbaijan, Iran., DeFalco FA; Neurology Service, Villa dei Fiori Hospital - Acerra, Naples, Italy., Switzer JA; Department of Neurology, Medical College of Georgia, Augusta, ME, USA., Blacker DJ; Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia; Department of Neurology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia; School of Medicine and Pharmacology, University of Western Australia., Dijkgraaf MG; Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Nederkoorn PJ; Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands., van de Beek D; Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Center, Amsterdam, The Netherlands.
Jazyk:	angličtina
Zdroj:	European stroke journal [Eur Stroke J] 2021 Dec; Vol. 6 (4), pp. 385-394. Date of Electronic Publication: 2021 Nov 03.
DOI:	10.1177/23969873211056445
Abstrakt:	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. Competing Interests: Declaration of conflicting interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: WFW, JDV, CJS, AK, JH, LK, AM, AC, JJC, YR, MRAN, FAF, JAS, MGWD, PJN, DvdB declare no competing interests. DB is clinical advisor and stockholder in Argenica Therapeutics, a biotech company developing a neuroprotective drug. (© European Stroke Organisation 2021.)
Databáze:	MEDLINE
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