The Frequency of Poststroke Infections and Their Impact on Early Stroke Outcome

Popović, Nataša; Stefanović-Budimkić, Maja; Mitrović, Nenad; Urošević, Aleksandar; Milošević, Branko; Pelemiš, Mijomir; Jevtović, Djordje; Beslac-Bumbasirevic, Ljiljana; Jovanović, Dejana

doi:10.1016/j.jstrokecerebrovasdis.2013.03.003

Cited by 46 publications

(35 citation statements)

References 32 publications

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“…Infections frequently complicate the acute phase of stroke and have been associated with unfavorable outcome in stroke patients [1]. The high risk for post-stroke infection is at least partly driven by a stroke-induced immune suppression, which is hypothesized to be caused by increased sympathetic activity [2].…”

Section: Introductionmentioning

confidence: 99%

Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Westendorp

Vermeij²,

Brouwer³

et al. 2016

Cerebrovasc Dis

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Background: Stroke-associated infections occur frequently and are associated with unfavorable outcome. Previous cohort studies suggest a protective effect of beta-blockers (BBs) against infections. A sympathetic drive may increase immune suppression and infections. Aim: This study is aimed at investigating the association between BB treatment at baseline and post-stroke infection in the Preventive Antibiotics in Stroke Study (PASS), a prospective clinical trial. Methods: We performed an exploratory analysis in PASS, 2,538 patients with acute phase of stroke (24 h after onset) were randomized to ceftriaxone (intravenous, 2 g per day for 4 days) in addition to stroke unit care, or standard stroke unit care without preventive antibiotic treatment. All clinical data, including use of BBs, was prospectively collected. Infection was diagnosed by the treating physician, and independently by an expert panel blinded for all other data. Multivariable analysis was performed to investigate the relation between BB treatment and infection rate. Results: Infection, as defined by the physician, occurred in 348 of 2,538 patients (14%). Multivariable analysis showed that the use of BBs at baseline was associated with the development of infection during clinical course (adjusted OR (aOR) 1.61, 95% CI 1.19-2.18; p < 0.01). BB use at baseline was also associated with the development of pneumonia (aOR 1.56, 95% CI 1.05-2.30; p = 0.03). Baseline BB use was not associated with mortality (aOR 1.14, 95% CI 0.84-1.53; p = 0.41) or unfavorable outcome at 3 months (aOR 1.10, 95% CI 0.89-1.35; p = 0.39). Conclusions: Patients treated with BBs prior to stroke have a higher rate of infection and pneumonia.

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Section: Introductionmentioning

confidence: 99%

Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Westendorp

Vermeij²,

Brouwer³

et al. 2016

Cerebrovasc Dis

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“…Sepsis and pneumonia are common, and highly morbid, infectious complications in stroke patients (1). The development of post-stroke infection leads to multiple poor outcomes including neurologic deterioration (2), prolonged hospital length of stay (3), poor functional outcome, and death (4). The high clinical impact and limited effective strategies for prevention or treatment of post-stroke infection indicate the need for further investigation into underlying mechanisms and potential therapeutic options.…”

Section: Introductionmentioning

confidence: 99%

Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke

Colbert

Traystman

Poisson

et al. 2016

Journal of Stroke and Cerebrovascular Diseases

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Background and Goal Infectious complications after ischemic stroke are frequent and lead to neurologic deterioration, poor functional outcomes, and higher mortality. Local and systemic inflammatory responses to brain ischemia differ between males and females, but little is known about differences in post-stroke susceptibility to infection by sex. The purpose of this study was to compare sex-related differences in the risk of hospital-acquired sepsis and pneumonia after acute ischemic stroke (AIS). Materials and Methods This was a retrospective, secondary analysis of the 2010–2011 California State Inpatient Database. Previously validated ICD-9 codes were used to identify adult hospitalizations for AIS. The primary outcome was hospital-acquired sepsis or pneumonia, also identified using ICD-9 codes. Associations between sex and hospital-acquired sepsis or pneumonia were adjusted for baseline characteristics and comorbidities using multivariable logistic regression. Findings There were 91,643 visits for AIS included in this analysis, of which 1,027 had hospital-acquired sepsis and 1,225 had hospital-acquired pneumonia. The in-hospital mortality without infection was 4.6%; the presence of hospital-acquired infections was associated with higher mortality for sepsis (32.7%) and pneumonia (21.9%). Female (vs. male) sex was associated with a lower adjusted odds of hospital-acquired sepsis (OR 0.74, 95%CI 0.65–0.84) and pneumonia (OR 0.69, 95%CI 0.62–0.78). This difference was similar across age strata. Among visits with either hospital-acquired sepsis or pneumonia, sex did not influence mortality. Conclusions Female sex was associated with a lower risk of hospital-acquired sepsis and pneumonia after AIS. Further investigation is needed to determine the mechanisms underlying this clinical observation.

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“…It is often followed by complications, especially infections, which occur in 30% of stroke patients and are strongly associated with unfavorable outcomes and high mortality123. Pneumonia and urinary tract infections were the most common types of post-stroke infections2.…”

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confidence: 99%

The Efficacy of Prophylactic Antibiotics on Post-Stroke Infections: An Updated Systematic Review and Meta-Analysis

Liu

Xiong

Zhang

et al. 2016

Sci Rep

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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.

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The Frequency of Poststroke Infections and Their Impact on Early Stroke Outcome

Cited by 46 publications

References 32 publications

Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Pre-Stroke Use of Beta-Blockers Does Not Lower Post-Stroke Infection Rate: An Exploratory Analysis of the Preventive Antibiotics in Stroke Study

Sex-Related Differences in the Risk of Hospital-Acquired Sepsis and Pneumonia Post Acute Ischemic Stroke

The Efficacy of Prophylactic Antibiotics on Post-Stroke Infections: An Updated Systematic Review and Meta-Analysis

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