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

  • External authors:
  • Willeke F Westendorp
  • Jan-dirk Vermeij
  • John Hodsoll
  • Lalit Kalra
  • Andreas Meisel
  • Angel Chamorro
  • Jason J Chang
  • Yousef Rezaei
  • Mohammad R Amiri-nikpour
  • Fabrizio A Defalco
  • Jeffrey A Switzer
  • David J Blacker
  • Marcel Gw Dijkgraaf
  • Paul J Nederkoorn
  • Diederik Van De Beek

Standard

Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials. / Westendorp, Willeke F; Vermeij, Jan-dirk; Smith, Craig J; Kishore, Amit K; Hodsoll, John; Kalra, Lalit; Meisel, Andreas; Chamorro, Angel; Chang, Jason J; Rezaei, Yousef; Amiri-nikpour, Mohammad R; Defalco, Fabrizio A; Switzer, Jeffrey A; Blacker, David J; Dijkgraaf, Marcel Gw; Nederkoorn, Paul J; Van De Beek, Diederik.

In: European Stroke Journal, 03.11.2021.

Research output: Contribution to journalArticlepeer-review

Harvard

Westendorp, WF, Vermeij, J, 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 2021, 'Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials', European Stroke Journal. https://doi.org/10.1177/23969873211056445

APA

Westendorp, W. F., Vermeij, J., Smith, C. J., Kishore, A. K., Hodsoll, J., Kalra, L., Meisel, A., Chamorro, A., Chang, J. J., Rezaei, Y., Amiri-nikpour, M. R., Defalco, F. A., Switzer, J. A., Blacker, D. J., Dijkgraaf, M. G., Nederkoorn, P. J., & Van De Beek, D. (2021). Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials. European Stroke Journal. https://doi.org/10.1177/23969873211056445

Vancouver

Author

Westendorp, Willeke F ; Vermeij, Jan-dirk ; Smith, Craig J ; Kishore, Amit K ; Hodsoll, John ; Kalra, Lalit ; Meisel, Andreas ; Chamorro, Angel ; Chang, Jason J ; Rezaei, Yousef ; Amiri-nikpour, Mohammad R ; Defalco, Fabrizio A ; Switzer, Jeffrey A ; Blacker, David J ; Dijkgraaf, Marcel Gw ; Nederkoorn, Paul J ; Van De Beek, Diederik. / Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials. In: European Stroke Journal. 2021.

Bibtex

@article{9072266ce55c4e09b9d30781e04944b6,
title = "Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials",
abstract = "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-May 7th 2021), Embase (1947- May 7th 2021), CENTRAL (Sept 17th 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 predefined 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. ",
author = "Westendorp, {Willeke F} and Jan-dirk Vermeij and Smith, {Craig J} and Kishore, {Amit K} and John Hodsoll and Lalit Kalra and Andreas Meisel and Angel Chamorro and Chang, {Jason J} and Yousef Rezaei and Amiri-nikpour, {Mohammad R} and Defalco, {Fabrizio A} and Switzer, {Jeffrey A} and Blacker, {David J} and Dijkgraaf, {Marcel Gw} and Nederkoorn, {Paul J} and {Van De Beek}, Diederik",
year = "2021",
month = nov,
day = "3",
doi = "10.1177/23969873211056445",
language = "English",
journal = "European Stroke Journal",
issn = "2396-9873",
publisher = "Sage Publications Ltd",

}

RIS

TY - JOUR

T1 - Preventive antibiotic therapy in acute stroke patients: A systematic review and meta-analysis of individual patient data of randomized controlled trials

AU - Westendorp, Willeke F

AU - Vermeij, Jan-dirk

AU - Smith, Craig J

AU - Kishore, Amit K

AU - Hodsoll, John

AU - Kalra, Lalit

AU - Meisel, Andreas

AU - Chamorro, Angel

AU - Chang, Jason J

AU - Rezaei, Yousef

AU - Amiri-nikpour, Mohammad R

AU - Defalco, Fabrizio A

AU - Switzer, Jeffrey A

AU - Blacker, David J

AU - Dijkgraaf, Marcel Gw

AU - Nederkoorn, Paul J

AU - Van De Beek, Diederik

PY - 2021/11/3

Y1 - 2021/11/3

N2 - 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-May 7th 2021), Embase (1947- May 7th 2021), CENTRAL (Sept 17th 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 predefined 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.

AB - 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-May 7th 2021), Embase (1947- May 7th 2021), CENTRAL (Sept 17th 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 predefined 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.

U2 - 10.1177/23969873211056445

DO - 10.1177/23969873211056445

M3 - Article

JO - European Stroke Journal

JF - European Stroke Journal

SN - 2396-9873

ER -