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

Liang Liu1, Xiao-Yi Xiong1, Qin Zhang1

  • 1Department of Neurology, Xinqiao Hospital, The Third Military Medical University, No. 183, Xinqiao Main street, Shapingba District, Chongqing 400037, China.

Scientific Reports
|November 15, 2016
PubMed

Insights

Prophylactic antibiotics in acute stroke patients reduced overall infections, particularly urinary tract infections. However, they did not significantly decrease post-stroke pneumonia rates or improve mortality and functional outcomes.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Post-stroke infections are frequent complications in acute stroke patients, often leading to poor functional outcomes.
  • Existing research on prophylactic antibiotic use for preventing these infections and improving outcomes presents conflicting findings, particularly concerning post-stroke pneumonia.

Purpose of the Study:

  • To systematically review and meta-analyze the effects of prophylactic antibiotic treatment on post-stroke infections, pneumonia rates, mortality, and functional outcomes in acute stroke patients.

Main Methods:

  • A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted.
  • Searches were performed in PubMed, Embase, and Web of Knowledge databases up to March 11th, 2016.
  • Seven RCTs involving 4261 patients were included in the analysis.

Main Results:

  • Preventive antibiotics significantly reduced the overall incidence of infections in acute stroke patients (OR = 0.57, P = 0.005), notably urinary tract infections (OR = 0.34, P < 0.001).
  • No significant reduction was observed in the rate of post-stroke pneumonia (OR = 0.91, P = 0.385).
  • Antibiotic treatment showed no significant effect on mortality (OR = 1.07, P = 0.743) or functional outcomes measured by the modified Rankin Scale (OR = 1.76, P = 0.124).

Conclusions:

  • Prophylactic antibiotic treatment in acute stroke patients effectively decreases the risk of overall infections, especially urinary tract infections.
  • However, this preventive strategy does not significantly lower the incidence of post-stroke pneumonia, reduce mortality, or improve functional outcomes.
  • Based on current evidence, prophylactic antibiotic treatment is not recommended for acute stroke patients.

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