title: Antibiotic therapy for preventing infections in patients with acute stroke.
abstract: 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 infections and improve outcome.
  
  
  OBJECTIVE
  1. To assess whether preventive antibiotic therapy in patients with acute stroke reduces the risk of dependency and death at follow-up. 2. To assess whether preventive antibiotic therapy in patients with acute stroke reduces infection rate.
  
  
  METHODS
  We searched the Cochrane Stroke Group's Trials Register (October 2010); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 3); MEDLINE (1950 to October 2010) and EMBASE (1980 to October 2010). In an effort to identify further published, unpublished and ongoing trials we searched trials and research registers, scanned reference lists and contacted authors, colleagues and researchers in the field.
  
  
  METHODS
  Randomised controlled trials (RCTs) of preventive antibiotic therapy versus control (placebo or open control) in patients with acute ischaemic or haemorrhagic stroke.
  
  
  METHODS
  Two authors independently selected articles and performed data extraction; we discussed and resolved discrepancies in a consensus meeting with a third observer. We contacted the study authors to obtain missing data when required. An independent observer assessed methodological quality. We calculated relative risks (RRs) for dichotomous outcomes, assessed heterogeneity amongst included studies and performed subgroup analyses on study quality.
  
  
  RESULTS
  We included five studies involving 506 patients. Study population, study design, type of antibiotic and definition of infection differed considerably. The number of patients who died in the preventive antibiotic group was non-significantly reduced (33/248 (13%) versus 38/258 (15%), RR 0.85, 95% confidence interval (CI) 0.47 to 1.51); the number of dependent patients in the preventive antibiotic therapy group was also non-significantly reduced (97/208 (47%) versus 127/208 (61%), RR 0.67, 95% CI 0.32 to 1.43). Preventive antibiotic therapy did reduce the incidence of infections in patients with acute stroke from 36% to 22% (36/166 (22%) versus 61/169 (36%), RR 0.58, 95% CI 0.43 to 0.79). No major side-effects of preventive antibiotic therapy were reported.
  
  
  CONCLUSIONS
  In this meta-analysis, preventive antibiotic therapy seemed to reduce the risk of infection, but did not reduce the number of dependent or deceased patients. However, the included studies were small and heterogeneous. Large randomised trials are urgently needed.
authors.affiliation: Department ofNeurology,Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Willeke F
authors.initials: WF
authors.lastname: Westendorp
authors.forename: Jan-Dirk
authors.initials: JD
authors.lastname: Vermeij
authors.forename: Frederique
authors.initials: F
authors.lastname: Vermeij
authors.forename: Heleen M
authors.initials: HM
authors.lastname: Den Hertog
authors.forename: Diederik W J
authors.initials: DW
authors.lastname: Dippel
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Nederkoorn
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis / Q000379:methods; D001424:Bacterial Infections / Q000401:mortality / Q000517:prevention & control*; D002545:Brain Ischemia / Q000150:complications; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000150:complications* / Q000401:mortality
chemical_list: D000900:Anti-Bacterial Agents