title: Prophylactic antibiotic treatment in severe acute ischemic stroke: the Antimicrobial chemopRrophylaxis for Ischemic STrokE In MaceDonIa-Thrace Study (ARISTEIDIS).
abstract: Infections represent a leading cause of mortality in patients with acute ischemic stroke, but it is unclear whether prophylactic antibiotic treatment improves the outcome. We aimed to evaluate the effects of this treatment on infection incidence and short-term mortality. This was a pragmatic, prospective multicenter real-world analysis of previously independent consecutive patients with acute ischemic stroke who were >18 years, and who had at admission National Institutes of Health Stroke Scale (NIHSS) >11. Patients with infection at admission or during the preceding month, with axillary temperature at admission >37 °C, with chronic inflammatory diseases or under treatment with corticosteroids were excluded from the study. Among 110 patients (44.5 % males, 80.2 ± 6.8 years), 31 (28.2 %) received prophylactic antibiotic treatment, mostly cefuroxime (n = 21). Prophylactic antibiotic treatment was administered to 51.4 % of patients who developed infection, and to 16.4 % of patients who did not (p < 0.001). Independent predictors of infection were NIHSS at admission [relative risk (RR) 1.16, 95 % confidence interval (CI) 1.08-1.26, p < 0.001] and prophylactic antibiotic treatment (RR 5.84, 95 % CI 2.03-16.79, p < 0.001). The proportion of patients who received prophylactic antibiotic treatment did not differ between patients who died during hospitalization and those discharged, or between patients who died during hospitalization or during follow-up and those who were alive 3 months after discharge. Prophylactic administration of antibiotics in patients with severe acute ischemic stroke is associated with an increased risk of infection during hospitalization, and does not affect short-term mortality risk.
authors.affiliation: First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tziomalos
authors.affiliation: Department of Medicine, Larissa University Hospital, Medical School, University of Thessaly, Larissa, 41110, Greece. gntaios@med.uth.gr.
authors.forename: George
authors.initials: G
authors.lastname: Ntaios
authors.affiliation: Third Department of Internal Medicine, Papageorgiou Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Spiros
authors.initials: S
authors.lastname: Miyakis
authors.affiliation: Second Department of Internal Medicine, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Papanas
authors.affiliation: Department of Internal Medicine, General Hospital of Drama, Drama, Greece.
authors.forename: Andreas
authors.initials: A
authors.lastname: Xanthis
authors.affiliation: Department of Internal Medicine, General Hospital of Goumenissa, Goumenissa, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Agapakis
authors.affiliation: Department of Medicine, Ioannina University Hospital, Medical School, University of Ioannina, Ioannina, Greece.
authors.forename: Haralampos
authors.initials: H
authors.lastname: Milionis
authors.affiliation: First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Savopoulos
authors.affiliation: Second Department of Internal Medicine, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece.
authors.forename: Efstratios
authors.initials: E
authors.lastname: Maltezos
authors.affiliation: First Propedeutic Department of Internal Medicine, AHEPA Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
authors.forename: Apostolos I
authors.initials: AI
authors.lastname: Hatzitolios
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000592:standards / Q000627:therapeutic use; D019072:Antibiotic Prophylaxis / Q000592:standards* / Q000706:statistics & numerical data; D002444:Cefuroxime / Q000592:standards / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008297:Male; D063868:Patient Outcome Assessment; D011014:Pneumonia / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D020521:Stroke / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology
chemical_list: D000900:Anti-Bacterial Agents; D002444:Cefuroxime
keywords: Acute ischemic stroke; Antibiotic prophylaxis; Decubitus ulcer infection; Outcome; Pneumonia; Stroke-related infection; Urinary tract infection