Abstract
Post-stroke infections are common complications in acute stroke patients and are associated with an unfavorable functional outcome. However, reports on the effects of prophylactic antibiotics treatment on post-stroke infections are conflicting, especially those on post-stroke pneumonia and outcomes. We searched the PubMed, Embase, and Web of Knowledge databases up through March 11th, 2016. Seven randomized controlled trials including 4261 patients were analyzed among this systematic review and meta-analysis. We found preventive antibiotics treatment at the time of stroke onset did reduce the incidence of infections in adults with acute stroke (OR = 0.57, 95% CI: 0.38–0.85, P = 0.005), including reducing the number of urinary tract infections (OR = 0.34, 95% CI: 0.26–0.46, P < 0.001), but did not significantly decrease the rate of post-stroke pneumonia (OR = 0.91, 95% CI: 0.73–1.13, P = 0.385). Importantly, antibiotics treatment also showed no significant effect on the number of fatalities among stroke patients (OR = 1.07, 95% CI: 0.90–1.26, P = 0.743) and functional outcome scores on the modified Rankin Scale (OR = 1.76, 95% CI: 0.86–3.63, p = 0.124). Our study indicated that preventive antibiotics treatment not reduced the rate of post-stroke pneumonia or mortality, even though decreased the risk of infections, especially urinary tract infections. Thus, preventive antibiotics treatment may not be recommended for acute stroke patients.
Highlights
Previous studies on the preventive use of antimicrobials in patients with acute stroke found conflicting results
The results of our meta-analysis suggested that preventive antibiotics treatment at the time of stroke onset reduced the occurrence of infections in adults with acute stroke (OR = 0.57, 95% confidence intervals (CIs): 0.38–0.85, P = 0.005) (Fig. 2A, Table 3)
In this meta-analysis, we found that prophylactic antibiotics did not reduce the incidence of pneumonia in adult patients with acute stroke (OR = 0.91, 95% CI: 0.73–1.13, P = 0.385) (Fig. 2B, Table 3) and other infections (OR = 1.00, 95% CI: 0.63–1.60, P = 0.996) (Supplementary Figure S1), but decreased the incidence of urinary tract infections significantly (OR = 0.34, 95% CI: 0.26–0.46, P < 0.001) (Fig. 2C, Table 3)
Summary
Previous studies on the preventive use of antimicrobials in patients with acute stroke found conflicting results. A meta-analysis including 506 patients concluded that prophylactic antibiotics treatment after the onset of stroke significantly reduced the infection rate without major adverse effects, but had no effect on the mortality rate. Since the previous meta-analysis, there have been more multicenter randomized controlled trials with larger samples. We performed this updated meta-analysis to systematically assess the effects of prophylactic antibiotics treatment on post-stroke infections and the occurrence of mortality among adult acute stroke patients. We first take a subgroup meta-analysis of the effects of the preventive use of antimicrobials on the rate of post-stroke pneumonia and urinary tract infections
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