Antibiotic therapy for preventing infections in people with acute stroke

医学 冲程(发动机) 科克伦图书馆 皮疹 不利影响 重症监护医学 抗生素 梅德林 入射(几何) 临床试验 随机对照试验 内科学 儿科 急诊医学 光学 物理 工程类 政治学 微生物学 法学 生物 机械工程
作者
Jan‐Dirk Vermeij,Willeke F. Westendorp,Diederik W.J. Dippel,Diederik van de Beek,Paul J. Nederkoorn
出处
期刊:The Cochrane library [Elsevier]
卷期号:2018 (1) 被引量:39
标识
DOI:10.1002/14651858.cd008530.pub3
摘要

Background Stroke is the main cause of disability in high‐income countries and ranks second as a cause of death worldwide. Infections occur frequently after stroke and may adversely affect outcome. Preventive antibiotic therapy in the acute phase of stroke may reduce the incidence of infections and improve outcome. In the previous version of this Cochrane Review, published in 2012, we found that antibiotics did reduce the risk of infection but did not reduce the number of dependent or deceased patients. However, included studies were small and heterogeneous. In 2015, two large clinical trials were published, warranting an update of this Review. Objectives To assess the effectiveness and safety of preventive antibiotic therapy in people with ischaemic or haemorrhagic stroke. We wished to determine whether preventive antibiotic therapy in people with acute stroke: • reduces the risk of a poor functional outcome (dependency and/or death) at follow‐up; • reduces the occurrence of infections in the acute phase of stroke; • reduces the occurrence of elevated body temperature (temperature ≥ 38° C) in the acute phase of stroke; • reduces length of hospital stay; or • leads to an increased rate of serious adverse events, such as anaphylactic shock, skin rash, or colonisation with antibiotic‐resistant micro‐organisms. Search methods We searched the Cochrane Stroke Group Trials Register (25 June 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 5; 25 June 2017) in the Cochrane Library; MEDLINE Ovid (1950 to 11 May 2017), and Embase Ovid (1980 to 11 May 2017). In an effort to identify further published, unpublished, and ongoing trials, we searched trials and research registers, scanned reference lists, and contacted trial authors, colleagues, and researchers in the field. Selection criteria Randomised controlled trials (RCTs) of preventive antibiotic therapy versus control (placebo or open control) in people with acute ischaemic or haemorrhagic stroke. Data collection and analysis Two review authors independently selected articles and extracted data; we discussed and resolved discrepancies at a consensus meeting with a third review author. We contacted study authors to obtain missing data when required. An independent review author assessed risk of bias using the Cochrane 'Risk of bias' tool. We calculated risk ratios (RRs) for dichotomous outcomes, assessed heterogeneity amongst included studies, and performed subgroup analyses on study quality. Main results We included eight studies involving 4488 participants. Regarding quality of evidence, trials showed differences in study population, study design, type of antibiotic, and definition of infection; however, primary outcomes among the included studies were consistent. Mortality rate in the preventive antibiotic group was not significantly different from that in the control group (373/2208 (17%) vs 360/2214 (16%); RR 1.03, 95% confidence interval (CI) 0.87 to 1.21; high‐quality evidence). The number of participants with a poor functional outcome (death or dependency) in the preventive antibiotic therapy group was also not significantly different from that in the control group (1158/2168 (53%) vs 1182/2164 (55%); RR 0.99, 95% CI 0.89 to 1.10; moderate‐quality evidence). However, preventive antibiotic therapy did significantly reduce the incidence of 'overall' infections in participants with acute stroke from 26% to 19% (408/2161 (19%) vs 558/2156 (26%); RR 0.71, 95% CI 0.58 to 0.88; high‐quality evidence). This finding was highly significant for urinary tract infections (81/2131 (4%) vs 204/2126 (10%); RR 0.40, 95% CI 0.32 to 0.51; high‐quality evidence), whereas no preventive effect for pneumonia was found (222/2131 (10%) vs 235/2126 (11%); RR 0.95, 95% CI 0.80 to 1.13; high‐quality evidence). No major side effects of preventive antibiotic therapy were reported. Only two studies qualitatively assessed the occurrence of elevated body temperature; therefore, these results could not be pooled. Only one study reported length of hospital stay. Authors' conclusions Preventive antibiotics had no effect on functional outcome or mortality, but significantly reduced the risk of 'overall' infections. This reduction was driven mainly by prevention of urinary tract infection; no effect for pneumonia was found.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
更新
PDF的下载单位、IP信息已删除 (2025-6-4)

科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
1秒前
珈蓝完成签到,获得积分10
1秒前
嘟嘟请让一让完成签到,获得积分10
2秒前
莫x莫完成签到 ,获得积分10
3秒前
bubble完成签到,获得积分10
4秒前
4秒前
万能图书馆应助sl采纳,获得10
4秒前
河丫应助sl采纳,获得10
4秒前
量子星尘发布了新的文献求助10
5秒前
科研人发布了新的文献求助10
5秒前
5秒前
魏莱关注了科研通微信公众号
6秒前
dd发布了新的文献求助10
7秒前
yifan92完成签到,获得积分10
8秒前
9秒前
灵巧的孤容完成签到,获得积分10
10秒前
袁翰将军发布了新的文献求助10
10秒前
a雪橙完成签到 ,获得积分10
12秒前
超帅的碱完成签到,获得积分10
12秒前
13秒前
陈大海完成签到,获得积分20
13秒前
LaTeXer给积极行天的求助进行了留言
13秒前
白斯特完成签到,获得积分10
14秒前
科研混子完成签到,获得积分10
14秒前
听雨完成签到 ,获得积分10
14秒前
jianglili完成签到 ,获得积分10
14秒前
思源应助王云骢采纳,获得10
15秒前
等待的航空完成签到 ,获得积分10
16秒前
顾矜应助乔安采纳,获得10
16秒前
雪ノ下詩乃完成签到,获得积分10
17秒前
神外之城发布了新的文献求助80
17秒前
科研人完成签到,获得积分10
19秒前
莫友安完成签到 ,获得积分10
19秒前
大个应助迅速曼冬采纳,获得10
20秒前
热心市民小红花应助阿湫采纳,获得10
21秒前
快乐战神没烦恼完成签到,获得积分10
21秒前
顾矜应助魏莱采纳,获得10
21秒前
SYLH应助Rollei采纳,获得10
21秒前
22秒前
dd完成签到,获得积分20
22秒前
高分求助中
【提示信息,请勿应助】关于scihub 10000
Les Mantodea de Guyane: Insecta, Polyneoptera [The Mantids of French Guiana] 3000
徐淮辽南地区新元古代叠层石及生物地层 3000
The Mother of All Tableaux: Order, Equivalence, and Geometry in the Large-scale Structure of Optimality Theory 3000
Global Eyelash Assessment scale (GEA) 1000
Picture Books with Same-sex Parented Families: Unintentional Censorship 550
Research on Disturbance Rejection Control Algorithm for Aerial Operation Robots 500
热门求助领域 (近24小时)
化学 材料科学 医学 生物 工程类 有机化学 生物化学 物理 内科学 纳米技术 计算机科学 化学工程 复合材料 遗传学 基因 物理化学 催化作用 冶金 细胞生物学 免疫学
热门帖子
关注 科研通微信公众号,转发送积分 4038446
求助须知:如何正确求助?哪些是违规求助? 3576149
关于积分的说明 11374627
捐赠科研通 3305875
什么是DOI,文献DOI怎么找? 1819354
邀请新用户注册赠送积分活动 892680
科研通“疑难数据库(出版商)”最低求助积分说明 815048