Abstract
BackgroundInfection is a common complication in acute stroke. Whether or not preventive antibiotics reduce the risk of infection or even lead to a favorable outcome and reduction of mortality after a stroke still remains equivocal. This review was performed to update the current knowledge on the effect and possible benefits of prophylactic antibiotic therapy in patients with stroke.MethodsA systematic review and meta-analysis of preventive antibiotics`effect on the incidence of infection, favorable outcome (mRS≤2) and mortality in patients with acute stroke is performed with relevant randomized controlled trials.ResultsSix studies were identified, involving 4125 participants. Compared with the control group, the treated groups were significantly less prone to suffer from early overall infections [RR = 0.52, 95%CI (0.39, 0.70), p<0.0001], early pneumonia [RR = 0.64, 95%CI (0.42, 0.96), p = 0.03] and early urinary tract infections [RR = 0.35, 95%CI (0.25, 0.48), p<0.00001]. However, there was no significant difference in overall mortality [RR = 1.07, 95%CI (0.90, 1.27), p = 0.44], early mortality [RR = 0.99, 95%CI (0.78, 1.26), p = 0.92], late mortality [RR = 1.12, 95%CI (0.94, 1.35), p = 0.21] or favorable outcome [RR = 1.00, 95%CI (0.92, 1.08), p = 0.98].ConclusionAlthough preventive antibiotic treatment did reduce the occurrence of early overall infections, early pneumonia and early urinary tract infection in patients with acute stroke, this advantage was not eventually translated to a favorable outcome and reduction in mortality. Future studies are warranted to identify any subgroup of stroke patients who might benefit from preventive antibiotic treatment.
Highlights
Infection is a common complication in the acute phase after a stroke and diagnosed in 21% to 65% of patients, with the most common infections being pneumonia and urinary tract infections [1,2,3,4,5,6,7]
Compared with the control group, the treated groups were significantly less prone to suffer from early overall infections [relative risk (RR) = 0.52, 95%confidence intervals (CI) (0.39, 0.70), p
Future studies are warranted to identify any subgroup of stroke patients who might benefit from preventive antibiotic treatment
Summary
Infection is a common complication in the acute phase after a stroke and diagnosed in 21% to 65% of patients, with the most common infections being pneumonia and urinary tract infections [1,2,3,4,5,6,7]. Many studies have shown infections in patients with a stroke to be associated with poor short- and long-term functional outcome as well as a higher mortality [4, 8,9,10]. While this view is well established, a few studies failed to support this hypothesis [11, 12]. Whether or not preventive antibiotics reduce the risk of infection or even lead to a favorable outcome and reduction of mortality after a stroke still remains equivocal. This review was performed to update the current knowledge on the effect and possible benefits of prophylactic antibiotic therapy in patients with stroke
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