Antibiotic Class and Outcome in Post-stroke Infections: An Individual Participant Data Pooled Analysis of VISTA-Acute

Area of Science:

• Neurology and Infectious Diseases
• Pharmacology and Therapeutics

Background:

• Post-stroke infections are common complications impacting patient outcomes.
• Antibiotics used for treatment possess diverse antimicrobial and anti-inflammatory properties.
• The influence of antibiotic class on recovery after stroke is not well-established.

Purpose of the Study:

• To determine if the class of antibiotic administered for post-stroke infections is associated with patient outcomes.
• To investigate the impact of different antibiotic classes on functional recovery, measured by the modified Rankin Scale (mRS).

Main Methods:

• Pooled analysis of individual participant data from the Virtual International Stroke Trials Archive (VISTA)-Acute.
• Inclusion criteria: ischemic stroke patients with infection treated with systemic antibiotics within 2 weeks of onset.
• Antibiotics categorized into eight classes; association with 90-day mRS assessed using ordinal logistic regression.

Main Results:

• 2,708 patients analyzed; 35% experienced pneumonia.
• Macrolide treatment associated with better 90-day mRS for any infection (OR 0.59) and pneumonia (OR 0.46).
• Carbapenems, cephalosporins, monobactams, penicillin/β-lactamase inhibitors, and aminoglycosides linked to less favorable outcomes.

Conclusions:

• Macrolides may offer favorable immune-modulatory effects in stroke-associated infections.
• Certain antibiotic classes (carbapenems, cephalosporins, monobactams, penicillin/β-lactamase inhibitors, aminoglycosides) were associated with poorer outcomes.
• Prospective studies are warranted to confirm the impact of antibiotic class on post-stroke infection treatment and outcomes.