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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.

Titel:	Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials.
Autor/in / Beteiligte Person:	Westendorp, WF ; Vermeij, JD ; Smith, CJ ; Kishore, AK ; Hodsoll, J ; Kalra, L ; Meisel, A ; Chamorro, A ; Chang, JJ ; Rezaei, Y ; Amiri-Nikpour, MR ; DeFalco, FA ; Switzer, JA ; Blacker, DJ ; Dijkgraaf, MG ; Nederkoorn, PJ ; van de Beek D
Link:	Full Text Finder (Volltext)
Zeitschrift:	European stroke journal, Jg. 6 (2021-12-01), Heft 4, S. 385-394
Veröffentlichung:	London : SAGE Publications Ltd, [2016]-, 2021
Medientyp:	academicJournal
ISSN:	2396-9881 (electronic)
DOI:	10.1177/23969873211056445
Sonstiges:	Nachgewiesen in: MEDLINE Sprachen: English Publication Type: Journal Article Language: English [Eur Stroke J] 2021 Dec; Vol. 6 (4), pp. 385-394. <i>Date of Electronic Publication: </i>2021 Nov 03. References: J Neurol. 2018 Aug;265(8):1871-1879. (PMID: 29948247) ; Lancet. 2015 Nov 7;386(10006):1835-44. (PMID: 26343840) ; Stroke. 1996 Mar;27(3):415-20. (PMID: 8610305) ; N Engl J Med. 2001 Mar 1;344(9):665-71. (PMID: 11228282) ; J Am Heart Assoc. 2015 Jan 13;4(1):e001307. (PMID: 25587017) ; Circ Res. 2017 Feb 3;120(3):439-448. (PMID: 28154096) ; Arch Neurol. 2009 Sep;66(9):1076-81. (PMID: 19752296) ; Stroke Res Treat. 2013;2013:362961. (PMID: 23691430) ; Neurology. 2011 Oct 4;77(14):1338-45. (PMID: 21940613) ; Neurology. 2007 Oct 2;69(14):1404-10. (PMID: 17909152) ; PLoS One. 2008 May 14;3(5):e2158. (PMID: 18478129) ; Stroke. 2005 Jul;36(7):1495-500. (PMID: 15961713) ; Int J Stroke. 2014 Dec;9(8):999-1005. (PMID: 25196780) ; PLoS One. 2015 Dec 23;10(12):e0145580. (PMID: 26697876) ; Cochrane Database Syst Rev. 2018 Jan 22;1:CD008530. (PMID: 29355906) ; Eur J Neurol. 2017 Nov;24(11):1384-1391. (PMID: 28929560) ; Stroke. 2013 Sep;44(9):2493-9. (PMID: 23868273) ; Acta Neurol Scand. 2015 Jan;131(1):45-50. (PMID: 25155474) ; Stroke. 2008 Apr;39(4):1220-7. (PMID: 18309164) ; Neurol India. 2012 Jan-Feb;60(1):23-8. (PMID: 22406775) ; Lancet. 2015 Apr 18;385(9977):1519-26. (PMID: 25612858) ; BMJ. 2010 Feb 05;340:c221. (PMID: 20139215) ; Stroke. 2017 Oct;48(10):2885-2887. (PMID: 28887388) ; Cerebrovasc Dis. 2009;27(5):465-71. (PMID: 19329851) ; Stroke. 2018 Jul;49(7):1602-1609. (PMID: 29915122) ; Stroke. 2012 Oct;43(10):2617-23. (PMID: 22798325) ; BMC Neurol. 2011 Sep 20;11:110. (PMID: 21933425) Contributed Indexing: Keywords: antibiotic therapy; infection; stroke Entry Date(s): Date Created: 20220328 Latest Revision: 20220329 Update Code: 20231215 PubMed Central ID: PMC8948510

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