Abstract
ObjectiveInfections are frequent after stroke and lead to increased mortality and neurological disability. Antibiotic prophylaxis has potential of decreasing the risk of infections and mortality and improving poor functional outcome. Several studies evaluated antibiotic prophylaxis for infections in acute stroke patients have generated conflicting results. The systematic review of randomized clinical trials (RCTs) aimed at comprehensively assessing the evidence of antibiotic prophylaxis for the treatment of acute stroke patients.Materials and MethodsPubMed, EMBASE, the Cochrane library and the reference lists of eligible articles were searched to identify all potential studies. We included the studies that investigated the efficacy and safety of antibiotic prophylaxis for the treatment of acute stroke patients. The primary outcome included mortality and infection rate. The secondary outcomes included poor functional outcome and adverse events.ResultsSeven trials randomizing 4,261 patients were included. Pooled analyses showed that antibiotic prophylaxis did not improve the mortality (risk ratio (RR) = 1.03, 95% confidence interval (CI) 0.84 to 1.26, p = 0.78, I2 = 25%) and poor functional outcome (RR = 0.93, 95% CI 0.80 to 1.08, p = 0.32, I2 = 80%), but reduced the incidence of infection (RR = 0.67, 95% CI 0.53 to 0.84, p = 0.0007, I2 = 49%). No major side effects were reported. Sensitivity analyses confirmed the results of infection rate and poor functional outcome.ConclusionsAntibiotic prophylaxis can be used to treat the infectious events of acute stroke patients although it has no potential of decreased mortality and improved functional outcome.
Highlights
Stroke is a major contributor to cardiocerebral vascular diseases-related disability and death worldwide, especially in low- and middle-income countries [1, 2]
Pooled analyses showed that antibiotic prophylaxis did not improve the mortality (risk ratio (RR) = 1.03, 95% confidence interval (CI) 0.84 to 1.26, p = 0.78, I2 = 25%) and poor functional outcome (RR = 0.93, 95% CI 0.80 to 1.08, p = 0.32, I2 = 80%), but reduced the incidence of infection (RR = 0.67, 95% CI 0.53 to 0.84, p = 0.0007, I2 = 49%)
Antibiotic prophylaxis can be used to treat the infectious events of acute stroke patients it has no potential of decreased mortality and improved functional outcome
Summary
Stroke is a major contributor to cardiocerebral vascular diseases-related disability and death worldwide, especially in low- and middle-income countries [1, 2]. Stroke impairs many vital neurological functions, but causes severe complications such as infections [3]. Previous definitions used for diagnosing infection were substantially different, and it was defined predominately based on the modified Centers for Disease Control and Prevention criteria [4]. About 5–65% of acute stroke patients are at risk of infection [5]. Of patients with post-stroke infection, 48% died compared to 18% patients without infection [5]. Several studies well demonstrated that post-stroke infection was associated with increased mortality and poor functional outcome [6, 7]. It is extremely important to effectively and successfully manage the infection following the stroke
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