Post-stroke infection in acute ischemic stroke patients treated with mechanical thrombectomy does not affect long-term outcome

Abstract

Introduction The impact of an infection that requires antibiotic treatment (IRAT) after an acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT) remains unclear. Aim Here, we studied the prevalence and the profile of IRAT in patients with AIS treated with MT, aiming to identify predictive factors and prognostic implications at 90 days after stroke. Material and methods We analyzed parameters available within 24 h after AIS including demographics, risk factors, National Institutes of Health Stroke Scale (NIHSS) upon admission and 24 h later, hemorrhagic transformation (HT) on computed tomography, and several clinical and biochemical markers. The outcome measures were the modified Rankin Scale (mRS) 0-2 and 90 days post-stroke mortality. Results We included 291 patients; in 184 (63.2%) patients MT was preceded by intravenous thrombolysis (IVT), and 83 (28.5%) patients developed IRAT. Multivariate analysis showed that male sex and hemorrhagic transformation on CT taken 24 h after stroke increased the risk of IRAT. We found that younger age, male sex, lower delta NIHSS, shorter time from stroke onset to groin puncture, better recanalization and a lack of hemorrhagic transformation on CT taken 24 h after stroke favorably affected outcome at day 90. Multivariate analysis showed that older age, higher delta NIHSS, unknown stroke etiology and lack of treatment with IVT were independent predictors of death up to day 90. Infection that required antibiotic treatment did not enter in the models for the studied outcome measures. Conclusions In AIS patients treated with MT, IRAT is not an independent factor that affects favorable outcome or mortality 90 days after stroke.

Association between hyperpyrexia and poststroke outcomes in patients with recanalization after mechanical thrombectomy: a retrospective cohort study

“…However, infection was not a factor that affected favorable outcome 90 days over 24 h after MT. These findings lend further support to the hypothesized detrimental influence of temperature elevation on the fate of ischemic tissues in the early aftermath of cerebrovascular injury, which were consistent with the research results of Nowak et al [ 33 ]. Several recent clinical trials tested preventive antibiotic therapy could reduce the occurrence of post-AIS infection and provided additional benefits over standard treatment [ 34 , 35 ].…”

Predicting Poststroke Pneumonia in Patients With Anterior Large Vessel Occlusion: A Prospective, Population-Based Stroke Registry Analysis

“…It can be assumed that the performance of EVT alone—especially in elderly patients with comorbidities—may contribute considerably to the risk of developing PSP, e.g., due to a decreased resilience and compensability of swallowing disorders ( 30 , 31 ), and that these factors may outweigh the additional detrimental (or beneficial) effects of a good or poor recanalization result. In consequence, stroke physicians should be aware in their clinical routine that a patient undergoing EVT is always at an increased risk of developing PSP, even if the intervention is successful ( 32 ).…”

The prognostic significance of large vessel occlusion in stroke patients treated by intravenous thrombolysis

“…We collected data on the use of antibiotics during hospitalization due to stroke-associated infection (SAI) (we distinguished those with and without SAI). The details about the diagnosis of infections have been reported elsewhere [ 18 ].…”